Appointment Request Form

   
   

* indicates a required field.

  
   

 
 

 
 
First Name*:
  
 
Last Name*:
  
 
Preferred Telephone (used to contact you about appointments) *:
  
 
Preferred E-mail Address*:
  
 
Emergency Contact Phone*:
  
 

My first choice for an appointment is:

 

  
 
Date*:
  
 
Time*:
 AM PM  
 
Service Type:
 Basic Massage
Stretching/Exercise Instruction
Tuina (Traditional Chinese Massage)
Pregnancy Massage
Hot Stone Massage 		 
 
If you are not sure whether you want basic massage or tuina, please click here to review the services offered, then return to this page to request your appointment.  
 
Massage Length:
 30 minutes 60 minutes 90 minutes  
 
I will pay by:
 Cash Check. Sorry we do not accept credit cards.  
 

My second choice for an appointment is:

 

  
 
Date*:
  
 
Time*:
 AM PM  
 
Service Type:
 Basic Massage
Stretching/Exercise Instruction
Tuina (Traditional Chinese Massage)
Pregnancy Massage
Hot Stone Massage 		 
    If you are not sure whether you want basic massage or tuina, please click here to review the services offered, then return to this page to request your appointment.  
 
Massage Length:
 30 minutes 60 minutes 90 minutes  
 
I will pay by:
 Cash Check. Sorry we do not accept credit cards.