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Integrated Performance Therapy

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Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
Quantum Membership with AO Scan	x $125.00	$125.00 per month
Total: $125.00	Coupon:

I understand and agree to abide by the cancellation and rescheduling policy of Integrated Performance Therapy. I will give a minimum 12-hour notice prior to my appointment time, if I need to cancel or reschedule, to allow others to book appointments in that time slot. If I do not show up for an appointment, the service will be deducted from my package, and I will not be refunded.