Maxi Rock Haus Massage Booking

Massage Appointment Booking Form

Hi, my name is Zakiya. I’m currently attending school for Medical Massage Therapy and have now gained the ability to accept clients in our student clinic. I’m eager to perfect my craft and provide quality massage services at a discounted rate. Each session is priced at $40 and lasts for 50 minutes. If you’d like a longer session, you can book two consecutive time slots for a 100-minute session. I welcome both male and female clients and strive to accommodate each client's needs with flexibility. Since I’m still in school, you’ll need to fill out some general intake forms at each appointment to confirm your medical background and legal liabilities. Looking forward to serving you!
Full Name*

First NameLast Name
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Are you a New Client*

YesNo
How did you hear about us?*

maxirockhaus.comInstagramFacebookFamily or Friend if so please list below
List Friends First & Last Name*
What’s your reason for a massage , what inspired you to book?*

general self care / relaxationpain or discomfort in the body
Do you have any allergies?*
this contains, product ingredients or fragrances.
Date Reservation*
SELECT APPOINTMENT SESSION TIME*
each session is approximately 50 minutes.
Should be Empty: