Massage Appointment Request
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Email *
Name *
Please enter the name you go by and your last name.
Phone number
Please enter your number if we may contact you via phone call or text message.
Pronouns
What pronouns do you use? Select all that apply or enter your own. (Don't know what this means? https://time.com/4327915/gender-neutral-pronouns)
Your therapist
Do you have a preference of how your therapist identifies? ( All of us identify as at least one of the following.) Select all that apply:
What style of massage would you like? *
How do you identify (Optional) If you identify as Transgender or BIPOC, are you wanting to use scholarship for this appointment? (up to $50)
What is your general availability to receive a massage? *
Please enter the days and times that best suit your schedule.
Privacy Policy and Cancellation Policy *
Required
A copy of your responses will be emailed to the address you provided.
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