Contact Us

Get in touch with Angelica.

Register below to let us know you want to sign up for our sports moms group. We will meet virtually on Mondays at 1PM. We will follow up with an email after the form is submitted.

First name

Last name

Phone

I confirm that I am in the state of California, and will be for sessions.

How did you hear about this group?

Will you be using insurance?

Yes

By submitting this form through Restoring Vida Therapy’s web portal, I acknowledge and accept the risks associated with communicating personal and health information via unencrypted email and electronic messaging. I choose to proceed despite these risks and agree not to hold Restoring Vida Therapy liable for any unauthorized access, use, or disclosure of this information. I understand that if I become a client, I will be given access to a secure client portal for future communication.

We will get back to you soon. If you have any questions before then please feel free to email us at info@restoringvidatherapy.com