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Release Form

If you have been requested to have this form completed, please>

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  1. Print the Form

  2. Have it completed by your physician or surgeon depending on the circumstance.

   3. Bring the completed form with you to your next session. 

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This form must be in your file records for our liability and insurance purposes.

Click the link below

Ashiatsu Massage

Find Us:

 

Physical Address:

129B W Swannanoa Ave

Liberty, NC 27298

Entrance is located off of Public Parking across from the red caboose.

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Mailing Address:

PO Box 547

Alamance, NC 27201

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E-Mail: jaimelpikelmbt@gmail.com

Tel: 336-715-0222

Hours

 

Monday 8:30am-2pm

Tuesday 8:30am-2pm

Wednesday 8:30am-2pm

Thursday 8:30-2pm

Friday 8:30am-2pm

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We hope to add evening and Saturday hours back in soon. Please fill out our form to be notified when these hours open.

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Links We Like

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Jaime L Pike​

NC L.M.B.T.# 19660

Provided by North Carolina Licensed Massage and Bodywork Therapist

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©2025 by Body Balance Therapeutic Massage

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