Membership Cancellation Request

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Membership(Required)

I am sending this written notice to notify you that I am requesting cancellation of the following membership:

Cancellation Details(Required)

I have decided to cancel for the following reasons:

Cancellation Date(Required)

I would like for this cancellation to go into effect on:

Please send me written confirmation of my membership cancellation within 30 days of my receipt to this letter.

LUXE Membership Terms and Conditions can be found here.

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Dr. Corey L. Hartman

Dr. Rayna M. Dyck

Dr. Kathryn O. Luckett

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Alison Hayes, CRNP

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Kaitlyn Green, LE

Nicole Lambertson, LE

Emily Bush, LE