Maitri Wellness Center

To schedule your free phone consultation and claim your coupon code, please complete the following intake form

First Name *

Last Name *

Email *

Phone

For what issue are you seeking treatment? *

Have you ever received treatment from acupuncture and Chinese Medicine? *

Yes

What results do you envision for yourself? *

How did you hear about us?

Yes, I would like to receive text message notifications at the phone number provided above from Maitri Wellness Center for appointment reminders. I understand I will receive up to 4 messages a month. Data rates may apply. Reply STOP to opt-out.

I agree to the terms & conditions and privacy policy provided by Maitri Wellness Center.

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