Renew your body, mind and spirit

Please use this form to contact us for information or to reserve your session

We require cancellation of appointments within 24 hours of appointment or you will be charged for your session.  

See more about our cancellation or late arrival policy before registering. Thank you!

 

  PERSONAL INFORMATION
Name
Address
City
State
Zip
Phone (day)   Fill in best contact phone
Phone (cell)
Phone (eve)
Email
  See Event registration info below (Mother's Day, Retreats)
   
  PREFERENCES FOR REGULAR MASSAGE SESSIONS

Type of massage you're interested in

Choose more than one if desired:

Integrative   Swedish   Reflexology    Trager Method

 

Shiatsu       Think Right Now Massage

 

Choose one:  

Table massage           Chair massage

 

Location:

At our location    (In home visits available for additional fee )

Friday Evening Massage Clinic - ($45) Location announced at registration time

 

 

Additional Services:    (Require additional fees for each - see Massage page)

In Home                    Aromatherapy 

 

Hot Stone                  Think Right Now Programs

 

Day or Date
Time of day

Length of Massage

30 minutes           1 hour              1.5 hour

  

MASSAGE PACKAGES AVAILABLE: (see massage page for prices)

5 one hour table massages

5 one & half hour table massages

5 thirty minute chair massages

5 one hour chair massages

 

   Additional info - Please fill in for Massage sessions and events
For who For myself                 This is a gift

Is this a Corporate Group or Event?

(Describe in Comments)

Corporate Group      Event     Other
Are you interested in info about our PMS test group or PMS Relief Massage? Yes          No
Please list all health conditions. Also note surgeries or injuries within the last 3 years
Comments
I agree to the cancellation / late arrival policy Yes      No         See cancel / late arrival policy

  Thank you - We will contact you as soon as possible!

   

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Ithaca Breast Cancer Alliance