STEPS HOW TO BOOK A MASSAGE APPOINTMENT

1. Fill - out a questionnaire below.
2. Proceed with a 20% deposit to book your appointment.
3. Message Vitaliy to confirm your payment & submission.
4. Get your massage treatment in my home studio! During a FIRST appointment, you will be also asked to fill in, an Informed Consent and Health History Form + each treatment will include ~ 10-15 minutes consultation, going through main complaint, proper general and specific assessment, allowing us to create a specific approach based on our findings.
5. Receive your receipt after massage therapy services provided & full payment is made.

*IMPORTANT for Insurance Claims* My services may not be covered yet by some insurance companies (Blue Cross especially), because it takes ~ 4-8 weeks for my application as a provider to go through (I’ve applied for all major insurance companies already, however, it takes time for them to process my application).

Have questions ? message me + 1 (204) 232 - 5452 OR rmtjackedhamster@gmail.com

Name

First Name

Last Name

Email

Phone

(###)

###

####

Duration of Massage

Pricing is the same for both Remedial and Relaxation massage therapy. Hence, you see only the duration of massage services.

30 minutes - 63$ (after tax)

45 minutes - 84$ (after tax)

60 minutes - 105$ (after tax)

Which method of payment would you like to use ?

(After you will submit this form, please make the 20% deposit (or full price, based on personal preference) and then email or iMessage, or WhatsApp message (preferred) to Vitaliy Demchuk at rmtjackedhamster@gmail.com or + 1 (204) 232 - 5452 to confirm the payment transaction, the method of payment, and completion of your questionnaire. After I will receive full payment and provide the massage service, I will send you a receipt manually.

E-transfer ➡️ rmtjackedhamster@gmail.com

PayPal ➡️ PayPal.Me/vitaliyjackedhamster

Massage Preferences

Remedial massage - more focused on therapeutic treatment, of a specific dysfunction. Relaxation massage - general relaxation, decreasing muscle tension and stress.

Relaxation Massage

Remedial Massage

Area/areas you would like to focus on? What is your main complaint?

We will cover more details, during our in-person appointment. This is just for my reference, prior to massage.

Allergies to specific lotions ? Or any other type of allergies?

Date and Time, you'd like to receive a massage ?

After this form is submitted, I will follow up with you to confirm the exact time and date of our appointment. My schedule: Monday - Wednesday: 9 a.m. - 9 p.m. Thursday: 1 p.m. - 9 p.m. Friday - Saturday: 9 a.m. - 8 p.m. Sunday: 1 p.m. - 8 p.m.

Invoice & Insurance Claims Policy

By filling and agreeing to this questionnaire, you (client/recipient) accept that I (Vitaliy Demchuk and Jacked hamster Inc.) are not registered for direct billing with insurance companies (yet). You will receive an official receipt after a full payment has been made and service provided, for you to submit to your insurance provider. 🔸 It is your responsibility to: • Verify your insurance coverage before your appointment. • Submit the receipt to your insurer for potential reimbursement. • Contact your insurer with any questions or issues regarding reimbursement. ❗️No refund policy. I am not responsible for denied claims or unpaid reimbursements from your insurance company. No refunds will be issued due to insurance non-payment, and or/cancelled appointment, and/or no shows. If you press "No, I do not agree", please exit the questionnaire and do not book an appointment with me. Thank you for your understanding.

Yes, I understand and agree.

No, I do not agree.