Massage Therapy Interest Form

First Name Last Name Email Phone Number Which facility are you interested in? Peninsula Middle Peninsula Are you a member of Riverside Wellness & Fitness Center? Yes No What time of day would you prefer? Morning (9:00 – 12:00 pm) Midday (1:00 pm – 3:00 pm) Evening (4:00 pm – 7:00 pm) Weekends (9:00 am – 2:00 pm) What days are most convenient for you? Monday Tuesday Wednesday Thursday Friday Saturday Sunday What type of therapist do you prefer? Male therapist Female therapist No preference Are you currently suffering from any severe, acute, contagious, uncontrolled or undiagnosed conditions that would prevent you from receiving massage therapy? No Yes Unsure *If yes or unsure is selected, a massage therapist will contact you to discuss your condition prior to scheduling your massage.