Online Massage Appointment (time slots)

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

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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