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Please download and complete the appropriate forms for the service you will be receiving.

Bring the completed forms with you to your appointment. 

Holistic HealthCare Services Forms  
 

BodyTalk / Lymphatic Drainage / Fascia Balancing

Informed Consent

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Bali B Logo WHITE abbreviated .png

Wellness Intake Form

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CC Authorization

Contact Bali Holistic Wellness 

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1 Commons Drive Bldg C #18

Londonderry NH 03053

info@balihw.com

1-877-603-BALI
 

Hours: By Appointment Only M: Closed T: 8:30 - 5:30 W: 8:30 - 5:30 TH: 8:30 - 8:00 F: 8:30 - 3:30 Limited Saturdays 10:00-2:00

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© 2025 Bali Holistic Wellness Center

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