This form is to be completed by the event coordinator or other event/site representative ("The Representative") who agrees to be the primary point of contact between the party requesting chair massage services ("The Organization") and Gabrielle Brown-Wing ("The Massage Therapist").  While I make every effort to accommodate all requests, I cannot guarantee immediate availability, especially for clients outside of the Portland area.

Please note that this is not a legally binding contract, and that I reserve the right to refuse service as legally appropriate to maintain personal safety and/or adhere to my scope of practice as a massage therapist.

Please keep in mind that communication over the internet is not secure. Though unlikely, information submitted through this form may be intercepted and read by other parties besides the intended recipient. Please do not include your birth date, social security number, medical conditions, or other sensitive information in this form.

Once your form has been received, you may expect to be contacted within 1-4 business days. Thank you for your interest, I look forward to working with you!