The Muscle Sculptor - Joanie Ching (503) 544-9937 Professional Member
American Massage
Therapy Association
       
    

   Massage Reservation Request Form
Please fill out the request form as completely as possible.  This request is NOT a confirmation of an appointment. I will contact you to finalize your request. If you have not heard from me in a reasonable amount of time and would like to inquire about your request please call me at (503) 544-9937.
Thank you and I look forward to doing business with you!

Date Massage needed*
 (Please use MM/DD/YYYY format)
Time*
     AM   PM
Massage Length*
 1 hour   1½ hour   2 hour  
Type of Massage
(if known)
Deep Tissue
Relaxation
Swedish
Injury Care or Chronic Pain Relief
Sports
Prenatal
Person Massage is for*
Service Site Name
 (If business, business name. If apartment, apartment complex name.)
Address*
City*
State*
Zip*
Requestor's Name
 (If different than person receiving the massage.)
Phone Number*
 (Of the person receiving the massage.)
Requestor's Phone number
 (If different than person receiving the massage.)
Confirm to Email*
Special Location Instructions
(For example: "Set up table in back yard. Park in any uncovered parking stall. Security gate code:245.")
Other Pertinent Information

* = required
For confirmation purposes information from this form will be displayed when submitted. If this does not happen please let us know by calling (503) 544-9937. Thank you.
Please note that due to scheduling conflicts, not all massage requests will be filled.
All information provided on this form is held with utmost confidentiality.
The Muscle Sculptor maintains ethical standards by all service providers and administrative staff.

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