Shiatsu Massage Company - Vancouver

CONTACT: Tania Marshall, RST ... 604-837-3239
Time and Date: ____________________________

Chair-Massage Sign-Up Sheet
LOCATION:____________________________________
( Print out in LANDSCAPE mode)
Massage Number
Name
 Session

Please allow

5

minutes between massages
Times
Contact
Notes
Full name of person receiving massage
 Indicate 15, 20 or 30 minute session
START .- END
 Phone and Ext.  
1
            
2
            
3
            
4
            
5
            
6
            
7
            
8
            
9
            
10
            

Advise the therapist of any injuries, medical conditions, low blood pressure or pregnancy. Please remove watches, necklaces, name tags, pagers and cellphones. Thank You!

 

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