CROSSINGS CLIENT INFORMATION FORM First Name Last Name Address City State Zip Home Phone Cell Phone Email Address Date of Birth Occupation Emergency Contact Emergency Contact Phone Crossings Newsletter is an important way for us to stay in touch with you regarding any changes to our services and/or offerings. Would you like to receive the Crossings Newsletter? YesNo How would you like to receive Appointment Reminders? TextEmail Is there any discretion necessary when contacting you about your appointment time at home or work? If yes, please specify. How did you hear about Crossings? Please specify. Cancellation Policy: Most of our practitioners follow a 24 hour cancellation policy. Please reach out to your practitioner directly for specific details. Due to the reduced schedules for all practitioners please respect their treatment times that have been saved for you.