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First name
Last name
Email address
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Please send me information about
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Reflexology classes: diploma program & continuing education
Reflexology client benefits and information
BOTH reflexology class and client information
Your state (or country if living outside the US)
Primary phone number
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Cell phone number (for texted notifications)
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Reflexology practice zip code (for referrals)
Washington reflexology certification (RF) Number
Reflexology practice website address
Anything else we should know about your practice?
Are you interested in a specific elective class?
Client information
Current or past client at SRMC
Have not yet experienced reflexology at SRMC
Purchased or redeemed a gift certificate
Student background
No bodywork license
CR: Washington State Certified Reflexologist
NBCR: ARCB Certified Reflexologist
LMP/LMT: Licensed Massage Practitioner/Therapist
Esthetician
Nail Tech
Acupuncturist
Physical Therapist
Registered Nurse / Certified Nursing or Medical Assistant
Naturopathic Doctor
Medical Doctor
Podiatrist
Cosmetologist
Reflexologist legally practicing in a state other than Washington
Reflexology association memberships
Washington Reflexology Association (WRA)
Reflexology Association of America (RAA)
International Council or Reflexologists (ICR)
Oregon Reflexology Network (ORN) or Reflexology Association of Oregon (RAO)
Other state/national membership (ACARET or other)
Reflexology Association of California (RAC)
How did you hear about us?
Internet search
Referral by SRMC client, student or representative
Referral by a reflexologist
Referral by non-reflexology practitioner
Facebook
WRA
ARCB
RAA
ICR
Find Touch
Yelp
SRMC guest instructor's website or advertisement
At a class or presentation about reflexology
DiscoveryPoint Massage School
Your esthetician association
Brenneke, Brian Utting or Cortiva
Everest, Ashmead, or Seattle Massage School
Purchased or redeemed a gift certificate
Bill Flocco / American Academy of Reflexology
LinkedIn
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