Manual Client Appointment Request Form

NOTE: You are utilizing an alternate form of scheduling that IS NOT instant. If you use this manual form, I ask for at least 8 HOURS ADVANCE NOTICE to allow sufficient time for me to respond to this request and for us to communicate about available appointment slots.

If you desire an instant appointment, please utilize my online scheduling system on a device loaded with updated Flash Player Software.

To use this form to schedule an appointment, complete and submit the form below. Once received, I will usually respond to you within a few minutes to a few hours.

Your contact information:

First Name

Last Name

Phone

E-mail

I would like to schedule the following session:

1 Hour Swedish Massage : Light Pressure
1.25 Hour Swedish Massage : Light Pressure
1.5 Hour Swedish Massage : Light Pressure
2 Hour Swedish Massage : Light Pressure
2.5 Hour Swedish Massage : Light Pressure

1 Hour Swedish Massage : Medium Pressure
1.25 Hour Swedish Massage : Medium Pressure
1.5 Hour Swedish Massage : Medium Pressure
2 Hour Swedish Massage : Medium Pressure

1 Hour Therapeutic Massage
1.25 Hour Therapeutic Massage
1.5 Hour Therapeutic Massage
2 Hour Therapeutic Massage

1 Hour Sports Massage
1.25 Hour Sports Massage
1.5 Hour Sports Massage
2 Hour Sports Massage

1.25 Hour Tantra Session
1.5 Hour Tantra Session
2 Hour Tantra Session
2.5 Hour Tantra Session
3 Hour Tantra Session

1 Hour Powder Massage

1 Hour Therapeutic Couples Massage Session
1.25 Hour Therapeutic Couples Massage Session
1.5 Hour Therapeutic Couples Massage Session
2 Hour Therapeutic Couples Massage Session
2.5 Hour Therapeutic Couples Massage Session
3 Hour Therapeutic Couples Massage Session

1 Hour Sensual Couples Massage Session
1.25 Hour Sensual Couples Massage Session
1.5 Hour Sensual Couples Massage Session
2 Hour Sensual Couples Massage Session
2.5 Hour Sensual Couples Massage Session
3 Hour Sensual Couples Massage Session

1 Hour BeCuddled Session
1.25 Hour BeCuddled Session
1.5 Hour BeCuddled Session

1 Hour Antera Consultation

1.25 Hour B.E./Taoist Session
1.5 Hour B.E./Taoist Session
2 Hour B.E./Taoist Session

1 Hour Tailored Session
1.25 Hour Tailored Session
1.5 Hour Tailored Session
2 Hour Tailored Session
2.5 Hour Tailored Session
3 Hour Tailored Session

I would like to add the following services to my appointment:

15-minute guided meditation: Add $15
15-minute powder massage: Add $20
Essential Oils: Add $5
15 Minute Dry Body Brushing: Add $15
Outcall travel with table: Add $50 (Note: outcall availability limited).
Outcall travel without table: Add $30 (Note: outcall availability limited).

I would like to schedule an appointment for the following date and time:

Special requests and/or changes to health status: