Name: E-Mail: Phone:

If you are interested in booking a session, please provide the following details:

Date of Session Time of Session: Duration: hours

The appointment is for myself my spouse / significant other my son /daughter my parent my other relative my friend work associates employees

Location (street address):

City or Township:

Apartment / Hotel Room Number:

Planned method of payment: Cash Credit Card PayPal eCheck Money Order Gift Certificate

Have you already paid for the session? Yes No

(If you have not already done so, and wish to pay now, please CLICK HERE)

Once this form is processed, you will be called back, and the session will be considered confirmed.

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Please check the following for the service(s) you are interested in booking:

Couples (side-by-side) Therapeutic Massage

4-Hand Therapeutic Massage

2-Hand Therapeutic Massage (one therapist only)

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Hotel Service Sports Massage

Massage For Moms Chronic Pain Management

Massage For Kids Massage Facelift

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Spa / Massage Parties

Massage Party Spa Party

Kids Parties

Kids Spa Party Kids Massage Party

Kids Yoga Party Kids Art Party

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Events & Celebrations

Event -type of event:

Corporate On-Site Massage -company name:

If you checked either of the above, please enter the approximate number of clients / guests:

Notes or questions:

PLEASE DO NOT SUBMIT ANY CREDIT CARD INFORMATION ON THIS FORM, OR IN AN E-MAIL. TO PAY NOW WITH PAYPAL, E-CHECK, OR CREDIT CARD, CLICK HERE TO GO TO OUR SECURE PAYMENT PROCESSING SERVER. OR, YOU MAY CALL US AND WE WILL PROCESS THE PAYMENT FOR YOU OVER THE PHONE.

(Please click 'Submit' at left to send this information to us)