First Name

Last Name

Phone *

Email *

How would you like your session to feel?

Open & Relaxed (door open, curtains open)

Semi-Private (curtains closed)

Fully Private (door closed & curtains closed)

What type of music for your session?

I am good with whatever you typically play

Meditation music ( Instrumental with nature sounds)

What pampering service would you like?

Would you be okay with doing a video/or written testimony of your before & after experience?

I am okay with that!!

I'd prefer not to

Please tell me two dates and times this month that would work best for you?

Why are you interested in this experience?

By Checking this box I understand a 25% Retainer is required to book this service. This 25% goes towards the balance and the remainder will be due at the time of service. Failure to show for your appointment will forfeit your retainer and there will be no refunds.

By Checking this box I understand I must inform Kierah within 24 hours of any cancellations that may arise, failure to do so may result in the inability to reschedule at the artists discretion. Failure to notify within 24 hours will forfeit your retainer.