Private Healing Service Request Form

Private Healing Services Request

Please send your request for a tailored Swan River wellness service and one of our staff members will respond to your request shortly.

[raw][contact-form subject=”Private Healing SERVICE REQUEST” to=””]
[contact-field label=”Name” type=”name” required=”true” /]
[contact-field label=”Email” type=”email” required=”true” /]
[contact-field label=”Phone number” type=”text” /]
[contact-field label=”Which type of service are you interested in?” type=”select” options=”Remote Online Session, Massage,Private Yoga,Acupuncture,Ayurvedic Counseling,Dharma Counseling,Harmonium/Chanting Lessons,Integrative Wellness Therapy,Intuitive Consultation,Reiki & Energy Medicine,Thai Yoga Therapeutics,Yoga Nidra,Other” /]
[contact-field label=”Which therapist would you like to work with?” type=”select” options=”No preference,Cynthia Krizo,Jamila White,Joe Stein,Keith Porteous,Kelly Haas,Megan Burns,Michelle Baker,Nady Persons,Nancy Maas,Natasha Mince-Parks,Serra Wobbema,Sara Bonar,Taylor Tidwell,TQ Sims,Other” /]
[contact-field label=”Comment” type=”textarea” required=”true” /]