Please Note: 24 hour notice must be given when cancelling appointments to avoid a cancellation or no-show fee of $30.00

We invite you to request an appointment using the following booking form, which will be sent directly to the East Windsor Massage Therapy Clinic. We will then contact you within one business day to confirm your appointment, using your preferred method of communication.

Please note that fields indicated with an asterisk (*) are required. We respect your privacy, and will not disclose ANY information to third parties.

We thank you for using our online appointment service!

Day/Evening Appointments Available

For immediate assistance, please call one of our clinics at 519-946-0210 (Jefferson) or 519-945-4441 (Wyandotte).

Client Information
Name: * First Last
Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone: * - ### - ### ####
Email *
Is this your first visit to East Windsor Massage Therapy Clinic?
Yes No
How did you hear about us?
Web Word of Mouth Newspaper Other
If "Other", please specify:
Appointment Information
Preferred Location: *
Days Available: *
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Preferred Date: * / MM / DD YYYY
Duration: *
Preferred Time (1st Choice): : HH MM AM/PM
Preferred Time (2nd Choice): : HH MM AM/PM
Choose a Therapist:
Clinic Services
What service(s) do you require?
Relaxation Massage Therapeutic Massage Pregnancy Massage Sports Massage Acute and Chronic Injury Rehabilitation Cupping Massage Indie Head Massage Thai Hot Stem Body Massage Thai Herbal Compress Massage Thai Hot Stem Facial Massage Myofascial Release Ashiatsu Barefoot Massage
Payment Information
What payment method will you be using? *
Debit, Credit Card, Cash Gift Certificate Direct Billing
Note: If Direct Billing is selected, a receipt will be given to clients who's insurance providers don’t allow payment to the therapist. Payment is required by client if insurance is at a maxed out balance or full payment wasn't issued to the therapist). All outstanding balances owing to the therapist must be paid in full within 30 days after being notified to avoid paying interest.
Please select your insurance provider: *
Green Shield Blue Cross Chambers of Commerce Cowan Desjardins Great West Life Industrial Alliance Johnson Inc Johnston Group Manulife Financial Maximum Benefit Standard Life Sun Life Other
Contact Information

How would you like to be contacted to confirm your request?
By phone at: - ### - ### ####
By email at:
By fax at: - ### - ### ####
Comments
Please add any comments or questions here:

Client Information

Appointment Information

Clinic Services

Payment Information

Contact Information

Comments