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I'd like to thank you for giving me this opportunity to assist you.

Please complete the form below and I'll respond shortly.

  

Questions, massage needs, info: *


Your contact information:

Full Name  * 

Email * 

Home Phone *  

Daytime Phone   

Extension 

Best Time to Call *  

Phone numbers should be input as  000-000-0000.
* Required Fields.

By submitting this form, I agree to give David Politte permission to contact me regarding my questions and comments, even if the phone numbers above are registered with the National Do Not Call Registry.

Forms to be completed:

Prior to your 1st massage session fill out Client Information form for my records.

If you wish to have an extra layer of confidentiality please fill out Confidentiality/non-disclosure form

A few other documents needed for Tui Na or Jin-shin Acu-touch assessment prior to session. Doc 1 & Doc 2

 
 

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