Thursday Request Form

Please complete the form below

Every other Thursday is open from 12pm-6pm but is subject to space availability. If you don’t see anything open in the online booking portal, please tell me the specific date of the Thursday you are requesting and times that work for you.

Name

First Name

Last Name

Email

Which service are you looking for?

Acupuncture, TMJ Relief, TMJ Massage, Sinus Relief, Revitalize Facial

Which Thursday date are you looking for?

ONLY CHOOSE A THURSDAY FOR THIS FORM

MM

DD

YYYY

Checkbox

CHECK ALL TIMES THAT WOULD WORK FOR YOU

12:00pm

1:00pm

2:00pm

3:00pm

4:00pm

5:00pm

6:00pm

Thursday Request Form

Please complete the form below

LAVENITA ACUPUNCTURE

Nest Wellness | 13-15 W 28th St | Suite 5R | New York, NY | 10001