Online Booking Request for New Clients

Online Booking Request
For New Clients

For Direct Deposit Payments, your therapist will supply you an invoice with banking details on the day. Sorry, no credit card facilities.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Address of Home, Accommodation or Workplace *

This is the address where we will visit

Any additional info? eg. parking, gate entry, dogs, etc. *

What dates & time frames suit you? *

Please provide at least 2 dates & time frames that would be suitable. List the first one as your preferred choice.

How would you like to pay? *

Cash on the Day Direct Deposit

For direct deposit option, I will supply an invoice with details for funds transfer.

Do you, or second person require a Health Fund Receipt? *

Yes No

Name your Health Fund/s *

What treatment would you like? Prices are for 1 Person *

30 Min Massage $50 (if booking for 2) 45 Min Massage $65 (if booking for 2) 1 Hr Massage $80 1.5 Hr Massage $115 2 Hr Massage $150

What treatment for second person? *

30 Min Massage 45 Min Massage 1 Hr Massage 1.5 Hr Massage 2 Hr Massage

A booking for 2 people is performed one after the other.

Name of second person *

If you require massage for more than 2 people, please list details below *

If you have had any serious injuries, medical conditions or operations in the last 6 months please list. *

Additional comments or queries *

I have read & agree to the Terms & Conditions *

Yes

Submit

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