Add Your Family To Your Membership

If you’ve recently purchased a Family Membership and not yet added your family to the subscription, please fill out the form below.

With a family membership, your partner and all dependents under 18 in the same house are entitled to discounted therapy, so it’s important we have their details on file as well as yours!

Your Details
The person who took out the membership
Name of the primary member*
First Last
Email*

This will help us identify you on our database
Your Family Members
Add all family members you'd like to include. Please leave any sections blank which are not relevant.
Name*
First Last
Date of Birth*

Day
Month
Year
Email
Relationship to you (son, partner, etc)
Name
First Last
Date of Birth

Day
Month
Year
Email
Relationship to you (son, partner, etc)
Name
First Last
Date of Birth

Day
Month
Year
Email
Relationship to you (son, partner, etc)
Name
First Last
Date of Birth

Day
Month
Year
Email
Relationship to you (son, partner, etc)
Name
First Last
Date of Birth

Day
Month
Year
Email
Relationship to you (son, partner, etc)

Add Your Family To Your Membership

Your Details

Your Family Members

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