Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

If you have questions before your first session, please call or text me at 678-978-8880.

Client Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )






( for Text Message Reminders )

Bill To Contact

/ Middle Initial







Emergency Contact

First Name
Last Name
Phone
Mobile
Relation
Email
Street Address
City
State
ZIP Code

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Payment information
Fees: Due at the end of each session. I accept cash, checks, Paypal and most credit cards.

Insurance:  I accept Aetna, Anthem Blue Cross Blue Shield, Cigna, Humana and Magellan. I also accept the following Employee Assistance Plans (EAP): KEPRO, Humana and Aetna.  


( Type Full Name )
( Full Name )