MYO MONDAY SIMONE SPECIAL PROMO- Form Submission Final Day! 8/4/25

Promotion Terms & Agreement Form

We’re excited to offer our Myo Monday Simone Special — a limited-time opportunity for patients to receive $100 off a bundle of 4 myofunctional therapy sessions with Simone, our newest therapist!

Promotion Details:

• Offer valid for active patients or patients of record only.

• Must purchase a 4-session bundle at the time of booking to qualify.

• All sessions must be scheduled for Mondays between 3:00 PM – 7:00 PM at our Chino Hills office.

• Full payment for the 4 sessions must be collected up front in a single transaction to receive the $100 discount.

• The total discount will be applied as $25 off per session.

• These sessions are non-transferable and must be completed with Simone only.

• This applies to regular 50 minute myofunctional therapy sessions.

• Exams and Functional Re assessments are Excluded

• No refunds will be issued once the package is purchased, regardless of attendance or cancellation.

Patient Acknowledgment & Agreement

By signing below, I confirm that I understand and agree to the terms of the “Myo Monday Simone Special” promotion. I acknowledge that:

• I am an active patient or a patient of record.

• I will schedule all 4 sessions for Mondays between 3:00 PM and 7:00 PM with Simone.

• I will pay in full at the time of booking to receive the $100 discount.

• I understand that the payment is non-refundable and non-transferable

• I understand that this only applies to regular myo sessions