Add your info
First and last name*
Are you willing to provide a state issued ID? This will be used for verification purposes and for the safety of the Massage Therapist.*
Yes
No
Would you like to schedule a 1st time appointment or join the Cancellation List?
Request an Appt Time
Join Cancellation List(Established Patients only)
Address*
Apartment, suite or unit number
City*
State*
Postal code*
Birthday*
Email address
Phone number*
Goals
Relaxation / Stress relief
Pain relief
Increase flexibility
Increase circulation
All of the above
Do you understand that Massage Therapy is healthcare and not part of the Sex Industry? *
Yes. There will be no harassment of any kind nor any sexual advances made
I understand that any therapist or office staff may refuse service at any time
I understand that a police report will be made if necessary for any form of harassment
I will forfeit my opportunity for therapy if I am inappropriate with any staff
There will be ZERO Tolerance for disrespect and dishonor.