Sliding Scale Application for Massage Services

Our commitment: We believe that healing should be accessible to everyone. If you are in financial need, please fill out this confidential form so we can explore offering services at a rate that honors both your budget and the value of our work.

Full Name

Phone

Email

What brings you to Tainica Therapeutics?

How many people are supported by this income (including yourself)?

Are there any financial challenges you'd like us to know about?

What price range feels manageable for you per session?

Do you have flexibility in your schedule to book during off-peak hours (weekday mornings/early afternoons)?

Yes

No

Maybe

Is there anything else you’d like to share with us?

Agreement | Please confirm:

I understand that sliding scale spots are limited and based on availability.

I agree to communicate promptly if my financial situation changes.

I acknowledge that this form is confidential and will only be used to assess my request.

Signature

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