Purchase a Gift Certificate

Your Name (this will be entered into the "From" field): *

Recipient's First Name *

Recipient's Last Name *

Message:

Collect Payment *

$ 100

$ 135

$ 200

$ 500

Other amount

This gift certificate will be applied to the account of the recipient named in this form. Refunds are not made available for gifted services; transfers can be made upon request. An expiration date of one year from the date the gift certificate will be established and included on the certificate. This value of the gift certificate may be used to purchase services through Ithaca Myofunctional Therapy, LLC.

I consent to these terms and conditions that apply to the purchase of the gift certificate.