BOOKING REQUEST Online Massage Booking Enquiry or Quote Request*BOOKING ENQUIRYQUOTATION*HomeWorkplaceEventFirst Name*Last Name*Company* Street Address City State Post Code Email* Phone*Further Details*Please outline the details of your booking ie; dates, number of people, booking time requested per person. *Change TypeHome BookingHome QuoteWorkplace BookingWorkplace QuoteEvent BookingEvent QuoteWe will respond to you within 24 hours, when requests are received between Monday to Friday during office hours 9am to 5pm If you are booking on behalf of the recipient please enter your details belowYour NamePhoneEmail Special instructions for parking or entryDate (1st Preference) Time (1st Preference) : HH MM AM PM Date (2nd Preference) Time (2nd Preference) : HH MM AM PM Massage OptionPlease SelectUltimate Indulgence - 60 minutesUltimate Indulgence - 90 minutesUltimate Indulgence - 2 hoursPerfect Partnership - 45 minutesPerfect Partnership - 60 minutesPerfect Partnership - 90 minutesPerfect Partnership - 2 hoursAged Care/Seniors - 30 minutesAged Care/Seniors - 45 minutesAged care/Seniors - 60 minutesGroup Bookings/OtherHealth Fund Rebates To claim health fund rebates please advise at the time of making your booking. Do you require a health fund receipt?YesNoHealth Fund NamePayment Options: We require payment when the booking is made, cash is not accepted at a first booking. You will be contacted for payment verification.CreditVisa CardMastercardAmexOtherVoucherCertificate NumberVerification CodeMemberMembership NumberPreferred Contact Phone Email CompanyExisting ClientNew ClientBooking DetailsPreferred date Preferred Time : HH MM AM PM Number of StaffHours required2 hours minimum per therapistLocationContact personContact PhoneEnter the contact phone numberLength of each massagePlease Select Time10 min15 min20 min30 minOtherWho is payingPlease Select OptionCompany FundedShared Cost between Company and StaffStaff Member pays Full CostContact Method Telephone Mobile Email Massage FrequencyPlease Select OptionWeeklyFortnightlyMonthlyQuarterlyOnce OffName of EventDate Time : HH MM AM PM Attendance NumberHours requiredmin 2hrs required per therapistAddress of EventContact Person at EventContact Phone at EventLength of each MassagePlease Select5 min10 min15 minOtherPreferred contact methodTelephoneEmailHow did you hear about usPlease Select OptionWeb Search EngineWeb Link ClickNatural Therapy PagesWord of MouthWould you like to receive our newsletter and special offers Yes Any Further Comments“We will respond to you within 24 hours, when requests are received between Monday to Friday during office hours 9am to 5pm” Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.
