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48 hour cancellation policy Form:

                Thank you for choosing massage/colonics as part of your healing path.  Due to the increasing demand for massage/colonics and the  limited appointments available, we try to discourage clients from canceling appointments last minute or from not showing up to their appointment.  When a client makes an appointment the space and time is reserved just for them.  The therapist turns away other clients at that time and comes to the office just for that appointment.  Therefore it is important to show up for the appointments that you make.  Due to this we have a 48 hour cancellation policy.

                The policy is as follows: If you fail to cancel your appointment within the 48 hours you will be charged the full price of the appointment.  When you sign this sheet you are verifying that you understand this policy and confirming that we may charge your credit card for any un-cancelled or missed appointments.

                This information will be kept confidential in our files and will not be shared with anyone or used for any other  purpose.  Also there is a $5.00 service fee for using the credit card machine that will be applied.

I  (print your name) ______________________________ understand this cancellation policy and give Adina Zeev permission to charge my credit card for any appointment not cancelled within the appropriate time and/or any appointments I do not show up for.  I understand also that this information can and will be used for no other purpose.

Write name on Card: ________________________________________________

Signature:__________________________________________________________

Credit Card Information needed:

Credit card #:___________________________________________

* Type of Credit Card: (circle one)  Visa  ,   Mastercard,  Discover,   American Express

* Expiration Date:        /           /            /

*CVV # (last 3 digits on back of the card:_______________________________

* Billing Address of the card: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you for your cooperation…

***If you do not fill out this form you will have to prepay for future appointments.

*** prepaid appointments are non refundable