Recurring Massage Formm

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Name* This field is required.
First Name
Last Name
2
Phone Number
Area Code
Phone Number
3
Email* This field is required.
example@example.com
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Do you have an account with Down Under Yoga? If you do not, please make one by visiting downunderyoga.com. Please include your credit card and sign the liability waiver. This will allow the Wellness Director to book your recurring appointments.
YESNO
5
Which Massage Therapist would you like to see for your recurring appointment?* This field is required.
No preference
Ann Appavoo (Master Therapist) (Brookline)
Rika Allien (Master Therapist) (Newton)
Paul D'Agostino (Brookline)
Rich Nadeau (Brookline)
Mukul Bhatt (Brookline)
Andre Villon (Harvard Square)
Lashea Williams (Back Bay)
Becca Phillips (Back Bay)
Maryella Robinson (Harvard Square)
Leila Timas (Harvard Square)
No preference
Not listed- (Please use notes below to specify)
6
Which location would you like to visit for your recurring appointments?You may only select one option.
Cambridge Harvard Square
Brookline
Newton
No Preference
Boston Back Bay
7
What frequency of recurring massage appointments would you like?Appointments are scheduled on the same day and time on a recurring basis. If you select a weekly appointment, you appointment will be every week. If you select bi- monthly your appointment will not be every other week, but instead will occur two times per month. For example, on the first and third Friday of the month or on the second and forth Friday of the month. If you select monthly your appointment will occur one time per month, for example on the third Monday of every month.
Weekly
Bi-Monthly (twice per month)
Monthly (once per month)
8
What frequency of appointments would you like?* This field is required.Appointments are scheduled on the same day and time on a recurring basis. If you select a weekly appointment, you appointment will be every week. If you select bi- monthly your appointment will not be every other week, but instead will occur two times per month. For example either on the first and third Friday of the month or on the second and forth Friday of the month. If you select monthly your appointment will occur one time per month, for example on the third Monday of every month.
Weekly
Bi- Monthly
Monthly
9
What length of appointment would you like?* This field is required.
60 mins ($85) (Senior Therapist $95)
75 mins ($100) (Senior Therapist $110)
90 mins ($110) (Senior Therapist $120)
120 mins ($150) (Senior Therapist $160) *Not available with all therapists
10
Are you able to commit to 6 appointments scheduled on the same day and time on a recurring schedule?* This field is required.*You are able to reschedule or skip 1 massage per every 6 booked. Recurring massage offers the best price for your massage. If you cannot commit please book drop in one time massage appointments or purchase our discounted 4 pack.
YESNO
11
Please provide 3 convenient days of the week and times for your recurring appointment.* This field is required.
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Please provide 2-3 convenient days and times for your recurring appointment.
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Do you accept the Terms and Conditions? * This field is required.Terms and Conditions: Cancellation must be made at least 24 hours prior to the appointment to receive an account credit; account credit does not expire and can be used towards any future purchase with Down Under. Cancellations within 24 hours of the appointment will result in no refund to either the account or card on file. For recurring appointments: The appointment payment will be processed up to 1 week prior to your appointment using the card on file in MindBody. An email receipt will automatically be sent upon processing.
YESNO
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Are there any additional considerations or questions you would like to add?
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