Schedule Appointment with Miracles In Massage

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First Name *

Last Name *

Phone *

Your E-Mail Address *

Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
45 Minute Massage		$95.00
Total: $95.00	Coupon:

I agree to provide a minimum of 24 hours when needing to change/cancel my appointment. If I provide less than 24 hours I am responsible for 100% of my appointment.