By submitting this form, you will be emailed (to the email account you provide below) a Discount Certificate worth 10% off at a participating facility. Once you receive the Discount Certificate via email, please print it out and present it to the clinic to be redeemed. Please note that the Certificate is not to be used in combination with other promotional discounts offered at this facility.
Please provide us with the following information and someone from this facility will contact you.
* Indicates required information.