Register to Book Sessions with Linda in Dallas, TX

NOTE: All required fields must be complete or form won't submit.
YOUR PRIVACY WILL BE ALWAYS RESPECTED. Privacy Statement below.
IF you find this form is not working for you, YOU MAY EMAIL THE BELOW INFO TO LKJFREE@YAHOO.COM
  First Name: Last Name:
  Mobile Phone #: Work Phone # (optional):
  Enter Preferred Email:    Other Email you may use(optional):
  Confirm Preferred Email:    Additional Email you may use (optional):
  How did you learn about my service?   * Check all that apply.
  SAW: You at clinic   Online Ad   LinkedIn Profile   Facebook   Other
  Which sessions are you interested in?   * Check all that apply.
1 hr. $100.   90 min. $140.   90 min w.LNM $160.   105 min w.LNM $180.   2hrs. $180.  2hrs. w.LNM $200.
  WHERE you Reside?   City   If Outside USA: Where?
 Please tell me something about YOU!   It can be Anything!
How often you get massage, active or sedentary lifestyle, occupation, health, age, sports, pets, hobbies you enjoy, work schedule, etc.
      I understand that I will need to pay CASH for services and agree to do so.
      I would like to pay with credit card if it becomes available.
 How may I contact you regarding an Appointment ~ Select Your Preference(s)
    Any method is fine   Email   Call Mobile Phone   Text-Message
  Like or want to try:
  Swedish
  Lomi Lomi
  Therapeutic
  Deep Tissue
  Medium Pressure
  Light Touch
  Trigger Point
  Glutes Massage
  Legs & inner thigh work
  Esalen-style w/minimal draping
  Lnm: Lymph Node Massage
 Want massage for:
  Try Your Service
  Stress Relief
  Pain Relief
  Health Reasons
  Relaxation
  Pleasure
  Escape from Reality
  To Feel Pampered
  Regular Basis
  Occasionally
  While in Dallas
  Your Body Size  
  		  Your Birthday (month)
  		Your Birthday (day)
 When were you born? (date range)
  Select the BEST day(s) to schedule a session
 Select the Best time(s) of day
REQUIRED FIELDS
Strictly Legitimate Massage
I understand that a strictly legitimate massage will be provided and will not ask for or expect illegal services.
Protocol for Cancellations
I will contact Linda as soon as possible if I must cancel an appointment. I understand that if I give less than 4 hrs notice (ever), I will NOT be booked again w/o FULL payment prior to appointment.
Protocol for Booking Appointments
I understand that if I request an appt. online and Linda replies to accept, that I MUST still reply back asap with Email, txt-msg, (or call) to confirm that I know my request was accepted. THEN my appt. will be "booked" and I will get an "Appt. Confirmed" message from Linda.
 
IF you see "Security Challenge Failed" Hit your browser's back Button to Try Captcha again!
Otherwise, it clears your form!!

Your Privacy is very important to me and any personal identifiable information you provide will NEVER be disclosed to outside parties.
Privacy policy

Registration for Massage with Linda Jimenez in Dallas, TX 75217