New Client Request Form

New Client Request Form

This form allows you the opportunity to *request* a Massage Therapy appointment with Jane Neldon, LMT. Currently, I am only accepting new clients by direct referral from a current client or medical practitioners at a *very limited* rate. Please be prepared to wait 2 weeks for an appointment opening.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
What day(s) of the week are you available for a massage therapy appointment?
What times during the day generally work best for scheduling a massage therapy appointment?

Other
If you looked at my scheduling website and saw a specific time that you're interested in, please list the date and time here:
Preferred Session Length
What are your goals for this massage session? (select all that apply)

Other
Who referred you to Jane Neldon, LMT?
Clients will only be accepted if directly referred by a current client or known medical practitioner.
If you are looking to redeem a gift certificate, please list the certificate's code number:
Any other information, comments, or questions?
Jane will contact you directly to confirm an appointment time and date.

If you do not receive an official confirmation, your appointment is not complete.

Additional information or questions can be sent to commonwealthmt@gmail.com

During this era of Covid-19 concerns, face masks are required by both myself and my clients throughout the entirety of the massage appointment.

No mask = no massage. No exceptions.

New Location Starting May 24, 2021:

2305 Commonwealth Drive, Charlottesville, VA 22901
Should be Empty: