Name *

First Name

Last Name

Which state are you located in? *

Maryland

Pennsylvania

Other

Please indicate your understanding of the following by checking one of the boxes below: *

McNulty Wellness Collective is an out-of-network provider and does not contract with any insurance companies. I am aware that I will be responsible for paying the full session fee ($200) at the end of each session, and have the option to submit to my insurance company for out-of-network reimbursement.

Yes, I understand.

Unclear, I have questions