Name* First Last Phone*Email* Preferred Therapist-- select a Therapist --Kristi Vincent, CMTMary Jiang, CMTPolly Zhao, CMTRebecca Zhou, CMTPatricia J. Bermudez, CMTLoan Geraci, CMTSteve Wang, CMTJaneel Rao, CMTDario Cordova, CMTJiong Qin, CMTLarry B., CMTSusan B., CMTSusan Cheng, L.Ac.,OMDAntonio Espinosa, CMTBonne Schulman-Rust, CMTLara Berthiaume, CMTPreferred Modality-- select a Modality --AcupunctureClinical Deep Tissue MassageLymphatic Drainage MassagePregnancy MassageMyofascial ReleaseTrigger Point ReleaseSports MassageSwedish MassageThai MassageReflexologyNeuromuscular ReleaseAcupressureShiatsu MassageReikiDeep Work MassageAdd-on: Fascial Stretching Therapy (15 or 30 min)Add-on: Scalp-Jawline-Face Massage (15 min or 30 min)Preferred Date* MM slash DD slash YYYY Preferred Time*9:30 am - 12 pm12 pm - 5 pm5 pm - 8 pm Δ
