Massage By Request
Please complete this entire form to request your massage session. Submission of this form DOES NOT guarantee your massage session reservation. You will receive a message from Exie Buehler regarding your request. If your request is accepted, you will receive an email confirmation with a request to complete an intake form and an invoice to prepay for your session.
Email address *
Name *
Your answer
Phone Number *
Your answer
Please choose which massage session you are requesting *
When are you requesting your session to be? (choose the week you are interested in having your session) *
MM
/
DD
/
YYYY
What days and times are you requesting for your session?
Please select all that apply
9:30am - 12pm
12:30pm - 4pm
4:30pm - 7:30pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Any other comments and/or questions?
Your answer
Please Note the following:
Form submission DOES NOT guarantee approval

PRE-PAYMENT REQUIRED and non-refundable**
Sessions cancelled if payment is not received 24 hrs in advance of appointment

Gift Certs and Discounts NOT ACCEPTED

Initial Fertility Massage session includes castor oil kit and instructions for home use. It is recommended that loose-fitting pants be worn for this session. Must be in between LMP and expected ovulation date. You will receive an additional reproductive history form to print and complete which needs to be brought to your session.

**Prep for Labor sessions cancelled at least 2 hrs in advance due to labor or early arrival of baby MAY receive store credit in amount paid to be applied to future massage sessions

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