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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.
E-Mail:*

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.
Massage*
  1 Hour Massage
T
Sub-Total:
Grand Total:
Billing Information
First Name:*

Middle Initial:

Last Name:*

Address Line 1:*

Address Line 2:

Apt. or Suite No.
City:*

State:*

Zip Code:*

Phone:

Credit/Debit Card Information
Card Number:*

Expiration Month:*

Expiration Year:*

Card Brand:*

Agreement
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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