Home Massage Request

Fill out the form to request home massage appointments.
One of our therapists will contact you within 24 hours.

Primary Contact Name *
Primary Contact Name
If we're seeing more than one client in one appointment, let us know who the primary contact will be.
Phone Number *
Phone Number
Home Address *
Home Address
In "Address 1", tell us your general location: Eastside, South End, North End, West Seattle, Seattle Metro. In "Address 2", tell us you exact location.
Describe the parking situation our therapist can expect.
Please list first and last name, and email address of additional clients being seen in one Home Massage visit.
Massage Menu *
Choose multiple if requesting for more than one person and service is different.
Nurturing Extras
These are complimentary. Choose any you'd like!
Consent *
The following is a consent for all potential clients listed on this request form: I understand that the body therapy I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain during the session, I will immediately notify the practitioner so that the work can be adjusted accordingly. I affirm that I have stated all known medical conditions, and answered all questions honestly. I understand that body therapy should not be used as a substitute for medical examination, diagnosis, or treatment and that I should see a qualified medical specialist for any mental or physical ailment that I am aware of. I understand that Nurture Home & Hospital Massage and the practitioners are not affiliated with the hospital. I do forever release Nurture Home & Hospital Massage, the practitioner, their insurers, and other agents from all liability whatsoever, whether past, present, or future for any damage which may occur to myself or my family as a result of my participation in this therapy.
Please tell us how you found us and anything else you'd like us to know.