This couple is enjoying a relaxing appointment at home after scheduling their massage appointment online. - Well Kneaded Massage, Inc.

Schedule A Massage Appointment Request Form

Company: *Only needed for office accounts
First Name:
Last Name:
Address:
Unit #:
City:
State:
Zip:
Home Phone:
Work Phone
Mobile Phone
E-Mail
Requested Date:
/
Start Time:
 : 
AM PM
End Time:
 : 
AM PM
Requested Therapy:
Requested Therapist:
Have you used our service before?
Yes   No
How did you hear about us?
What are your goals for this therapy?

Upon submitting your appointment request, you agree to the following policies & procedures:

Client agrees to complete a Client Intake Form prior to the start of their massage appointment. It is important that we know your medical history prior to treatment. This will help serve you and your health to the best of our capabilities.

Client agrees to pay full treatment cost for booked time if starting time begins late due to his/her tardiness. If your therapist has time, he/she will be happy to extend your service time. Otherwise, appointement will end as scheduled. Your therapist will arrive 15 minutes early to complete all necessary paper work and set up his/her equipment.

Client agrees to leave genitals, buttocks & breasts covered at all times. Though we understand many people are comfortable with nudity, it is against the law with respects to our profession. It also compromises the comfort level of our therapists. Our therapists reserve the right to end any session that compromises their comfort level or sense of safety and the client agrees to remit full payment for scheduled treatment.

Client agrees to pay a 50% charge of the appointment fee for cancellations given with less than 24 hours notice. A 100% appointment fee will be charged if less than 4 hours cancellation notice is provided. Our therapist's time is valuable and we appreciate your co-operation with this policy.

Once your massage appointment request has been submitted, you will receive a follow-up call from our office to complete and confirm your requested appointment.

Personal Massage Services