Focus Clinical Massage - 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
What best describes the type of service you're interested in
Corporate Massage or Wellness Program (ongoing services)
Employee Appreciation Event (one-time event)
What type of services do you want to offer?
NADA (National Acupuncture Detoxification Association) Group Treatments
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?
Every Other Week
If recurring, what day of the week is ideal?
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)
Participants are treated on a first come, first serve basis.
We'll use a paper sign up form.
Please provide us with an online sign up system (this is included with our services and we highly recommend using this)
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)
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service