You may download the form in your preferred file format from the Google Drive link above.

Options for filling out form:
1. Fill out electronically and email back to tamilyn.banno@gmail.com

2. Print form, fill it out, scan it back in and email to tamilyn.banno@gmail.com

3. Print, fill out, and mail to:
Soulside Healing Arts
1311 SW Adams St. Suite D
Peoria, IL 61602 

4. Print form, fill out, and bring to appointment (this may impact length of treatment)

5. If no access to printer, please arrive 10 minutes early to fill out form on site before appointment