Call or Text

Your Name *

Your Name

First Name

Last Name

Email Address *

Best Contact Phone #

(###)

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I am interested in booking/signing up for a

Watsu® Aquatic Massage

"Bonding & Baby Massage" Class

Pediatric One-on-One Session/Lesson

Prenatal & Babywearing Dance Class

How did you find/hear about Jillian?

Please provide details about your inquiry, interest (prenatal massage, special healthcare needs, group/organization, etc.) and availability *

Preferred Location *

Preferred Date

YYYY

Preferred session time

For Watsu sessions, please plan to be at the pool for at least 90 minutes to allow time for intake, transitions, etc.

Packages

I might be interested in purchasing a package for a discounted rate.