Waitlist Request
804-837-4292 | vhm.massage@gmail.com | www.vhm.massagetherapy.com
Important: Please only complete this form if there are no available appointments that work with your schedule after you've looked online. Please note, that if you are a new client, you will be required to complete our intake form. We will notify you if there is a cancellation or if there becomes an open appointment for the day your looking for.
Todays Date:
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Month
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Day
Year
Date
Client Full Name:
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First Name
Last Name
Email Address:
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example@example.com
Phone Number
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Area Code
Phone Number
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What type of notifications would you like to receive about available appointments? You can select more than one option. Remember, if your schedule changes, please let me know and I can update your notifications for you.
Morning Appointments (Before 12:00 PM)
Mid Day Appointments ( 12 to 4:00 PM)
Evening Appointments ( 4 to 7:00 PM)
ALL- Morning, Mid Day, and Evening Appointments
Weekends
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Please leave any comments or questions here for the therapist
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If you are visiting for the first time, you will be required to complete my intake form and prepay for your appointment before I can see you. You may prepay on the phone or I can send you and invoice from Square where you can pay using your debit/credit card. Thank you in advance for your understanding.
Thank You!
If you wish for me to stop sending you notifications, you can email me at vhm.massage@gmail.com
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