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Massage Appointment Request
I’m currently accepting new massage clients by referral only. Be sure to include the name of the person referring you when completing the form below and I’ll send you an email within 48 hours.
***If you have a gift certificate, do not complete this form. Start here:
https://balancechampaign.com/redeem-your-gift-certificate/
Questions? Email
karyn@balancechampaign.com
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* Indicates required question
First Name
*
Your answer
Last Name:
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
What is your experience with massage therapy?
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Your answer
What are your goals for seeking out massage therapy?
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Your answer
Preferred Days and Times
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Your answer
What length of Massage are you looking for?
*
60 minutes
90 minutes
Is there anything else that you'd like me to know
Your answer
Referred by:
*
Your answer
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