Therapist Application

Name:
Address:
City:
State:
Zip:
E-mail:
Phone:
Fax:
List cities where you would be willing to work:

Do you have liability insurance?

Yes
No

Check the license(s) you have:

State
City

Years of experience:

Do you have access to a massage chair?

Yes
No
 

12930 Ventura Blvd. Suite 916
Studio City, Ca. 91604

appointment@body-charge.com