Massage Payment Plan Agreement
For 12 massage sessions
LMT Brian Keene, Inside Shapiro Family Chiropractic
2121 S. Oneida St., Suite #420, Denver Co 80224
or SMART Bodywork® Mobile Massage
Email address *
First & Last Name *
Address *
Address #2 *
City *
State *
Zip *
Zip *
Phone *
Choose a Session Type *
Payment Plan Terms *
Massage Location *
If you chose Heat Therapy Treatment, please tell us which one:
I would like to include tip for my therapist in this payment plan agreement. I would like to tip: *
I am submitting a formal agreement to create a payment plan for massage services with SMART Bodywork and massage therapist Brian Keene LMT in Denver, Co. *
I understand I may request gift certificates and share my massage sessions with friends and family in the agreement and/or by submitting an email in advance to Subject: Share My Massage *
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