Scheduling Request Form - Rockford, IL

Massage Scheduling Instructions

This form should be used to request scheduling multiple massage appointments.  

Staff will use the information provided to schedule appointments for you and then send you a schedule to approve.  

If you have questions, please indicate on the form that you would like a call back to discuss.  

**Submitting a scheduling request does not guarantee an appointment or a rescheduled appointment. While we make every effort to accommodate your preferences, appointment times and provider availability may change. We strongly encourage flexibility when selecting providers and times—requests limited to a single provider may be more difficult to fulfill, especially if that provider’s availability changes. Patients who are open to multiple providers and time options are more likely to be scheduled promptly. Thank you for your understanding and cooperation.**

Day/Time - 1st Choice - Please select your 1st choice of day and the time preference for that day
Day/Time - 2nd Choice - Please select your 2nd choice of day and the time preference for that day
Day/Time - 3rd Choice - Please select your 3rd choice of day and the time preference for that day
Massage Therapist - Please select your top 3 preferred therapists

Consultation Request

Complete the Body Scan Tool
questionnaire.