NAMASTE SPA APPOINTMENT REQUEST

Please fill out the form below to request your appointment at Namaste Spa. Submission of this form does not guarantee requested dates, services or packages. A member of the Carpe Diem Team will contact you to confirm the details of your appointment.

Fields marked with * are required.

Contact Information

* First Name

* Last Name

* Street Address

Address Line 2

* City

State

COUNTRY

* Zip Code

* Phone Number

* Email Address

* Credit Card Type

* Credit Card Number

* CSC Code

* Expiration Date (mm/yy)

*
CANCELLATIONS WITHIN 48 HOURS BEFORE TREATMENT WILL BE CHARGED IN FULL

I AGREE

YES

NO

Appointment Details

MASSAGE SERVICES

DESIRED DURATION OF MASSAGE SERVICES

NUMBER OF TREATMENTS

________________________________

SCRUBS & POLISHES

DESIRED DURATION OF SCRUBS & POLISHES

NUMBER OF TREATMENTS

________________________________

ENERGY HEALING

DESIRED DURATION FOR ENERGY HEALING

NUMBER OF TREATMENTS

________________________________

* Treatment Date first treatment

Treatment Date addtl. treatment

* TIME FOR FIRST TREATMENT

TIME FOR ADDTL. TREATMENT

________________________________

PLEASE DO NOT SCHEDULE MULTIPLE TREATMENTS FOR THE SAME TIME.
ADDITIONAL TREATMENTS ON THE SAME DAY MUST BE SCHEDULED BACK TO BACK OR AT DIFFERENT TIMES DURING THE DAY

Comments

* Indicates Response Required