Serene Therapeutic Solutions

Client Inquiry/Appointment Form

Pen and Scroll Choose one: Client Inquiry Client Appointment

Enter your Name:
Enter your Street Address:
Enter your City:
Enter your State:
Enter your Zipcode:
Enter your Phone:
Enter your E-mail address:

What Services are you interested in using? Check all that apply:
Sweddish Massage
 Prenatal Massage
 CranioSacral Therapy
Aromatherapy Therapy Massage
 Spa Party
 Ear Candling
Infant Massage Classes
Do you want to schedule a bodywork appointment? Do you want to schedule a Spa Party date?

Date you want to schedule your bodywork service(s)?
Returning Customers--
Date of last service?

For Spa Party please fill in the selection below:

Date you want to schedule your Spa Party?
Location?
Your Home
Our Office Location
If your home, please list your address below.

For Infant Massage Classes please fill in the selection below:

Location? Baby being massaged

Your Home
Our Office Location
Private Class (one baby)
Group Class (max 3 babies in your home)
Group Class Organization/Institution
If your home, please list your address below.

If Organization/Institution, please list your Name and Address below.

Your request will be processed within two business day (Monday thru Friday).


Enter your comments here:

Thank you for your interest in Serene Therapeutic Solutions! Click to submit form:

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