Request Appointment / Contact If you would like to request an appointment, please fill out all of the boxes. If you are a current patient and have a question or concern, please fill out your name, email address, and your message. For any billing/insurance related concerns, please email our office manager at rosalie@lifebridgetherapy.com Go backYour message has been sent Name(required) Warning Email(required) Warning Phone number Warning Date of Birth Warning Insurance Company Warning Insurance ID number – include 3 letter alpha prefix if applicable Warning Message(required) Warning **By submitting this form via the website, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking the checkbox you agree to hold Life Bridge Therapy harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic form.** Warning I accept terms & conditions Warning Warning. SubmitSubmitting form Δ Share this: Click to share on X (Opens in new window) X Click to share on Facebook (Opens in new window) Facebook
Life Bridge Therapy 