Massage by Wendy Jo
Licensed Massage Therapist in Maine & Florida (NCBTMB and member of AMTA)
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Gift Certificate
Client Intake Form
Appointment
Prices
Bio
Treatment Info
Home
Gift Certificate
Client Intake Form
Appointment
Prices
Bio
Treatment Info
Appointment Request
Therapeutic and Relaxation Massage
Please complete the
client intake form
attached here and bring it to your appointment.
I’ll try to accommodate your request, but appointments get booked fast, so it is best to schedule a week in advance if possible.
Your Name
*
Email Address
*
Phone number
*
Appointment location
*
Please select location
Ellsworth, Maine Therapy Center
Your home (enter address below)
Office or work location (enter address below)
Other location (enter address below)
Street address
Number and street name
City
City or town
Notes to therapist (optional)
Type of therapy
Swedish
Deep tissue
Ashiatsu (at Ellsworth, Maine Therapy Center only)
Can be discussed at time of appointment.
First time massage?
Yes
No
Appointment date requested
*
Time Requested
*
Early morning
Late morning
Mid day
Early afternoon
Late afternoon
Other
Requested time subject to availability
Session Length
*
30 minute session
60 minute session
90 minute session
Other
Area of focus (optional)