Appointment Request Form

APPOINTMENT REQUEST FORM

This form is for booking in-home massage and lymphatic drainage services with Licensed Massage Therapist Angela Lind, License Number MA45645. Please provide accurate information so I can evaluate your request. After reviewing your location and availability, I will reach out with available dates to schedule your appointment. For more information about my services, visit www.Therapeutic-Hands.com

Important Coverage Notice in South Florida:
Please note that I only provide in-home massage services within West Broward or west of University Drive. This includes the following areas: West Sunrise, Plantation, Tamarac, Coral Springs, Parkland, Weston, West Davie, Cooper City, and Southwest Ranches. Also Pembroke Pines and Miramar only west of Flamingo Road. If you are located outside of these areas, I am unable to offer services at this time.
Full Name*

First NameMiddle NameLast Name
Address (where services will be provided)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*
E-mail*

Confirmation Email
Type of service you are interested in:*

Massage TherapyPost-Surgical Lymphatic DrainageLymphatic Drainage (Non-Surgical Related)Lymphedema ManagementLipedema ManagementOther
Please enter your preferred days and times for the appointment in the field below. Note that I am only available for appointments between 2 PM and 9 PM, so kindly provide times within this timeframe.*
Do I need to climb stairs to get to your place? (Whether outside your building or inside your house/condo where the massage table will be set up)*

YesNoOther
Additional Information: Share any details that may be relevant to your booking or session. (Optional)
Please note:

All available dates for booking are determined not only by availability but also by logistical considerations. Appointment times will be offered after reviewing your location and scheduling logistics.
Today's date
Signature*

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