Bambi's Bliss Utopia Table Intake Form
PLEASE FILL OUT THIS FORM COMPLETELY and text the word DONE to 317-762-6056 when finished. Forms must be filled out completely to receive your Customized Therapeutic Massage inside the Stutz Business Center at 1060 N. Capitol Ave Suite E-290 Indianapolis IN 46204
First and Last Name
Please select your method(s) of payment
Gift Card /Gift Certificate
Health Savings Account/Flex Spend Account
Health Insurance Claim
Do you have any vouchers or discount codes?
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