Healing Touch Therapy Mobile Spa Booking Form

Healing Touch Therapy Spa Booking Form

Request a massage appointment by selecting your preferred date and time and providing your contact, service, and location details. Your booking is not confirmed until Healing Touch Therapy Spa sends a confirmation.
Appointment Request
Preferred Appointment Date and Time
Service Type / Massage Session Requested
Session Length
Booking Acknowledgement
Client Information
Legal Full Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Best Phone Number for Appointment Day
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Contact Method
Service Location Details
Service Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Apartment / Unit / Room / Suite
Location Type
On-site Location Type
Access / Parking Notes
Property / Parking Details
Additional Location Instructions
Therapy Preferences
Primary Reason for Session
Areas of Concern
Pressure Preference
Medical Concerns and Allergy Concerns
Aromatherapy Preference ( Yes or No )
How did you hear about us?
If Family or Friend Please Name Them Below So We May Thank Them.
Disclosure and Informed Consent
I have read and understand the disclosure and informed-consent statements above.
Disclosure and Informed Consent

I understand that massage and bodywork are wellness and therapeutic services and are not a substitute for medical diagnosis, medical treatment, or emergency care. I agree to provide complete and accurate health information and to notify my therapist of any change in my health, medications, injuries, surgeries, pregnancy/postpartum status, or medical restrictions.

I understand that the therapist may modify, stop, postpone, or decline treatment if information or circumstances indicate that treatment may be inappropriate or unsafe. I agree to communicate discomfort, pain, dizziness, numbness, or other concerning symptoms during the session.

I understand that no specific outcome or result is guaranteed. I authorize Healing Touch Therapy Spa to provide the services I request after discussion with the therapist.

I further understand and agree that Healing Touch Therapy Spa and its staff are not liable for falls or injuries while getting on, off, or walking around the mobile spa.
A non-refundable deposit is required in order to be fully confirmed on the books. The deposit starts at $50 and may increase depending on location, number of people, and services rendered.
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Healing Touch Therapy Spa Booking Form

Appointment Request

Client Information

Service Location Details

Therapy Preferences