contactmegaform

Contact Info

Name: *

Company (if applicable)

Social Media Handle

Email: *

Mobile Phone: *

Preferred Communication Method: *

Phone Email

Best Time You can Be Reached: *

Preferred Language: *

English Spanish Arabic Other

Language you'd prefer...*

Inquiry Info

What Would You Like To Discuss? *

Overall, How satisfied were you with your visit today?

Video Testimonial Link (optional)

May We Publish Your Name & Testimonial On Our Website? *

Yes No

Testimonial *

Donations & Fundraising

Event Planning & Corp. Chair Massage

Book A Massage

Contact Us

Organization: *

Address: *

Type Of Donation: *

EIN/TIN# *

Name Of Project: *

Donation Due Date: *

Related Info 1:

Related Info 2:

Related Info 3:

Event Name: *

Event Location: *

Event Date: *

Start Time: *

End Time: *

Occasion: *

Please Specify: *

Event Description: *

Event Frequency: *

How Many Guests: *

Services Requested: *

Payment Option: *

Estimated Budget: *

Is Parking Provided? *

Yes No

Are Meals Available? *

Yes No

New or Exiting Appointment? *

Subject: *

Appointment Date: *

Appointment Time: *

Require rescheduling? *

Yes No

** Please call Customer Care M-F between 9:00 AM -7:00 PM to rebook your session. **

Current Appointment Date: *

Current Appointment Time: *

Proposed Appointment Date: *

Proposed Appointment Time: *

Please Specify: *

Mailing Address: *

City: *

State: *

Zip: *

Subject: *

Please upload your APPROVED -VA Form 10-7079 "Request for Outpatient Services" *

Do You Have A Prepaid Voucher (ie: Groupon)? *

Yes No

Voucher Type: *

Redemption Code (numeric located under bar code) *

Please Specify Details: *

Type Of Massage: *

Desired Intent (Expectation): *

Duration: *

Desired Pressure: *

Chief Complaints: *

Referred By: *

Please Specify: *

1st Appointment Choice: *

1st Appointment Desired Time *

Window of Availability:

If your preferred choices are unavailable, would you like to be waitlisted? *

Yes, please No, thanks

Would you like "The Staff" to book the NEXT available appointment? *

Yes, please No, thanks

How frequently will you need a massage? *

When did you receive your last massage? *

What type of massage did you receive?

Therapist Gender Preference *

Name: *

Email: *

Message:

Have an idea to help us improve? We want to hear it!

Did you have an issues with your massage experience? *

Yes No

Appointment Date: *

Time: *

Therapist Name: *

Please Rate Your Experience

Ease to make an appointment: *

Courtesy & Professionalism of Staff: *

Cleanliness of Facility: *

Massage: *

Would you recommend our business to your family, friends and co-workers? *

Yes No

How often do you receive massages? *

How did you hear about us? *

Please Specify: *

Are you having an issue with payment or refund? *

Yes No

Need additional Help? *

Mailing Address: *

City: *

State: *

Zip: *

This represents an agreement & understanding between Spirit Massage and...

hereinafter called CUSTOMER

LIABILITY

CUSTOMER understands that Spirit Massage requires Professional Liability Insurance Coverage for each of its subcontractors and will provide detailed policy information & verification of said coverage to CUSTOMER upon request.

INDEMNITY

CUSTOMER agrees, to indemnify and hold Spirit Massage, harmless from any claim, loss, cost, expense, demand, or damage, arising directly or indirectly out of the use of its on-site services and activities in connection therewith.

NON-SOLICITATION

CUSTOMER agrees not to solicit agents, subcontractors or representatives of Spirit Massage directly for employment, contract or otherwise.

PAYMENT

For the initial engagement, CUSTOMER agrees to supply a valid credit card to secure the booking and to submit payment on or before the date of service. For all subsequent engagements, CUSTOMER agrees to submit payment on a NET30 basis (30 days after invoice.) Payment is accepted by check or major credit card.

CANCELLATIONS

No refunds will be provided for deposits or cancellations received less than 24 hours before a scheduled appointment. Cancellations received between 72 and 48 hours before a scheduled appointment are eligible for a 75% refund, and cancellations received less than 48 hours before a scheduled appointment are eligible for a 50% refund. Additionally, events with 5 or more therapists that have been booked and confirmed, will incur a 10% non-refundable fee for any cancellation or change, at any time.

MISCELLANEOUS

The Terms of Service and the relationship between CUSTOMER and Spirit Massage shall be governed by the laws of the State of Virginia without regard to its conflict of law provisions. Customer and Spirit Massage agree to submit to the personal and exclusive jurisdiction of the courts located within the state of Virginia.

Name: *

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Enter Your Initials Here: *

Agreement

By submitting this form, I am representing myself as an agent of said company with the authority to agree to these terms of service.

Comments:

I accept the Terms and Conditions