Booking Form | Renewing Revolution-Nicole Lewis

Booking Form | Renewing Revolution

Renewing Revolution Nicole Lewis | Body-Mind Mentor Piqua Ohio | 567-228-9195 Virtual consultations are available before booking to help you explore the Service Menu, receive detailed answers to your questions, or discuss flexible payment plan options tailored to your needs. Please note that a consultation is REQUIRED before booking Mentoring Minutes (Option #3) or enrolling in The Body-Mind Mentoring Program (Option #4)

First Name

Last Name

Phone Number

Please briefly explain below why you are seeking care

Which options are you interested in booking? Choose all that apply

Option #1: Single Session Booking

Option #2: Bundled Sessions

Option #3: Bundled Sessions + Mentoring Minutes

Option #4: The Body-Mind Mentoring Program

I would like to explore these options together during a consultation

Please check any add-on services you are interested in. Check all that apply

guided breathwork

dry brushing

myofascial cupping

gua sha

facial cupping or gua sha

stone massage

aromatherapy

sound therapy

restorative stretch

energy work

guided meditation

I would like to explore these options together

I am not interested in any session add-ons

Have you had a massage before?

Yes

Do you want to book a virtual consultation? *Required when booking Option #3 or #4

Yes

What is your preferred method of contact to secure a date for your session? **Note: A phone call or video chat is recommended if you have questions or would like additional information before your session

via text

via phone call

via video chat

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