Name *

First Name

Last Name

I accept the terms of use *

By checking the box on the contact form, you agree to the Terms of Use listed here: Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use. By checking this box you hereby agree to hold Roots Acupuncture & Apothecary, its practitioners and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.