Wellness Registration

First Name (Required)

Last Name (Required)

Address (Line 1)

Address (Line 2)

City

State

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Zip

Phone

Email (Required)

Emergency Contact (Name and Phone Number) (Required)

Click here to download the EDGE Wellness Waiver

Please complete this form and bring it with you to your first session!

Are you an SMC Employee?

If yes, you will receive a half-price discount!

Payment Option

Cardholder Name (Required)

Credit Card # (Required)

Expiration Date (Required)

Security Code (Required)

cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

Billing Zip Code (Required)

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged