Make Appointment

Please fill out the form below listing your first two preferred dates and times.

For more information about appointments, including client forms, payment information, insurance information, and more, please visit our Appointment/Pricing Info page.

Cancellation Policy: Your appointment is scheduled specifically for you. You will be expected to give a 24-hour notice for all cancellations, except in the case of an emergency. Failure to do so will result in a cancellation fee equivalent to the full cost of the scheduled treatment session(s). Please remember to print, sign, and bring all client forms to your first appointment.

First Time Client? First Time Client? Yes No

First and Last Name

Preferred Method of Contact Preferred Method of Contact Email Phone

Phone Number

Email Address

Type of Treatment Type of Treatment 75 minute initial session 45 minute follow-up

First preferred date

Second preferred date

First preferred time

Second preferred time

Share any specifics Gina should know

How did you find Set Your Fascia Free?

Pricing Info

In-Person Visits

New pricing effective July 1, 2022

Initial Appointment
75 minutes (evaluation + treatment):
$150.00
Treatment Sessions
45 minutes: $95.00
75 minutes: $140.00
Wellness Package of four (4) 45 minute sessions: $340.00

** In order to continue to provide quality care into the future and to do so while maintaining my health, length of sessions will decrease by 15 minutes (from 90 to 75 and from 60 to 45). Prices will remain the same.

This is a cash-based physical therapy practice. Payment in full is expected at time of service. Cash, check or credit card are accepted. We are not a preferred provider for private insurance or Medicare.

Wellness Package: 4-45 Minute Treatment Sessions* In-Person Visits Only

For a total of $340 (excludes the initial appointment). This is a $40 savings.
Packages expire 1 year from date of purchase. Completion of Wellness Package is advised within 90 days of purchase in order to encourage consistent body work and to assist you in accelerating your journey to wellness.
Treatments within each package are non-refundable and non-transferable.

*Wellness package applies to in-person treatment sessions only.
*Wellness Package does not apply to those who are submitting claims to medical insurance or motor vehicle insurance, or to those who are in litigation.
* If you have purchased a Wellness package prior to July 1, 2022, the four 60 minute sessions will be honored until they are completed.

Telehealth Visits

Initial Appointment
60 minutes (evaluation + treatment): $125.00
Treatment Sessions
60 minutes: $85.00
30 minutes: $50.00