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Get in touch
555-555-5555
mymail@mailservice.com
Contact us
New Client Intake:
* Select Service >>
30 min. Neck/Back Massage ($50)
60 min. Massage ($80)
75 min. Massage ($100)
90 min. Massage ($120)
Thai Stretching ($75)
Manscaping ($40 & up)
Spa Facial ($70)
Heated Back Treatment ($75)
* First & Last Name:
* City, State:
* Email:
* Mobile Phone:
* Age:
* Select Height >>
4 ft. - 11 in. (and shorter)
5 ft.
5 ft. - 1 in.
5 ft. - 2 in.
5 ft. - 3 in.
5 ft. - 4 in.
5 ft. - 5 in.
5 ft. - 6 in.
5 ft. - 7 in.
5 ft. - 8 in.
5 ft. - 9 in.
5 ft. - 10 in.
5 ft. - 11 in.
6 ft.
6 ft. - 1 in.
6 ft. - 2 in.
6 ft. - 3 in.
6 ft. - 4 in.
6 ft. - 5 in.
6 ft. - 6 in.
6 ft. - 7 in. (and taller)
* Weight:
* Gender:
* How did you find me?:
Gift Card #(optional):
* Injuries, health issues & medications:
* Your Notes or Questions:
* Visiting? (select one):
- Visiting The Area
- I Live in the North Bay
* Please Confirm:
<-- No Flu or COVID symptoms
Thank you for taking the time to complete the intake form.
I will be in touch ASAP.
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