Focus Clinical Massage & Wellbeing

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Focus Clinical Massage & Wellbeing - Request Form

Thank you for your interest in our services. Please fill out this form to get the quickest and most accurate quote. Don't worry if you don't know all of the answers, we can work with you to find the best program for your needs. If you're having a problem with this form or you have other questions, email us at mk@focuscm.com

Email *

Company Name

Department Name

Event Location Address

Contact Name

Phone number

What best describes the type of service you're interested in

Corporate Massage or Wellness Program (ongoing services)

Employee Appreciation Event (one-time event)

Office Party

Health Fair

Marketing Event

Other:

Clear selection

What type of services do you want to offer?

Table Massage

Chair Massage

Yoga Therapy

Medical Acupuncture

NADA (National Acupuncture Detoxification Association) Group Treatments

Other:

If inquiring about hosting an event, please provide dates and times.

If you are interested in having an onsite therapist, how often do you want services?

Weekly

Every Other Week

Monthly, Quarterly

Other:

Clear selection

If recurring, what day of the week is ideal?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Clear selection

Expected # of Participants?

How long should each treatment session be?

Number of Practitioners Requested

(We can help you calculate this based on # of Participants and Treatment duration)

Scheduling Options:

Participants are treated on a first come, first serve basis.

Please provide us with an online sign up system (this is included with our services and we highly recommend using this)

Clear selection

Payment Options:

Company Pays 100% (Events options: Credit Card, ACH or check; Reoccurring options: ACH or check)

Employee Self Pay (Employee Pays 100%) (Credit/Debit Card, Apple/Samsung pay or Cash)

Company pays for basic service, Employee can pay for additional time/services.

Payroll Deduction Billed (We bill the company per hour and the company gets reimbursed from the employee through payroll deduction)

Payroll Deduction Direct withdraw (Set up a B2B account and Employee swipes their badge to pay us directly)

Other:

Clear selection

Additional Comments:

A copy of your responses will be emailed to the address you provided.

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