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Click on the symbol below to demonstrate scheduling an appointment from predefined appointment slots.

What makes this
form special?
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Massage Appointment
(predefined time slots)
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.

Book Appointment
When would you like your massage? Choose from our predefined time slots:
Massage Appointment*
Appointment Only
Massage Info
Massage Type*

1 hour Therapeutic

1 hour Relaxation

1 hour Hot Stone

1 hour Sports

1 hour Lymph Drainage

1 hour Pre-Natal

Do You have any special Instructions?
Yes No 

Special Instructions

24 hour cancellation notice is required to avoid being charged for your session.
  1 Hour Massage
Grand Total:
Billing Information
First Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

Apt. or Suite No.


Zip Code:*


Credit/Debit Card Information
Card Number:*

Expiration Month:*

Expiration Year:*

Card Brand:*

Client Agreement:
I understand that massage therapists do not diagnose illness, disease, any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform joint mobilization.
I acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that a physician be seen for that service.
It is my choice to receive massage as a form of therapy.

I hold harmless my massage therapist from any liability whatsoever.
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