Email Form — Michelle M Gray Massage Therapy

Street Address

City, State, Zip

Phone Number

Massage Therapy

Your Custom Text Here

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Massage

Preferred Date & Time

Message

Please list any accidents, injuries, surgeries, or other medical conditions the therapist needs to know about.

What results would you like from your massage session?

I understand that Massage Therapy is not a substitute for medical examination or diagnosis.

Yes

I agree to give 48 hour notice if I must cancel my appointment. If I do not give adequate notice, I will be charged 50% of the scheduled appointment.

Yes

Please note we are very communicative so if you don’t receive a response within 12 hours, please check your spam folder. Thank you!