Gift Certificate Request Form

Please complete the form below and I’ll reach out to confirm details and arrange payment and pickup/delivery.

Before you buy: Not everyone feels comfortable receiving hands-on bodywork during a cancer experience. If you’re unsure whether an in-person massage is the right gift, I recommend an “Ask Amy” consultation instead—these are easier to schedule and often especially useful for someone newly diagnosed or in treatment.

What You Need to Know

In-person services are available only to women with a breast cancer diagnosis or history.
Certificates can be purchased for both virtual consultations and in-person services.
Scheduling is subject to availability and usually requires 3–4 weeks’ notice.
All gift certificates are non-refundable, non-transferable, and expire one year from the purchase date.
Unused balances help support my Pay It Forward fund, making care more accessible to others.
Lost or stolen certificates cannot be replaced.

Recipient's Name:

As you would like it to appear on the gift certificate.

First Name

Last Name

Your (Giver's) Name:

As you would like it to appear on the gift certificate.

First Name

Last Name

Your Email:

Please provide the email for the contact handling the gift certificate.

Your Phone:

Please provide the phone number for the contact handling the gift certificate.

(###)

###

####

Gift Details:

Please select one option from the dropdown menu. If selecting custom please enter the amount in the next field.

Custom Dollar Amount

Please add the amount you would like to give if not opting for a preselected amount.

$

Method of Delivery:

Please select how you would like to handle pick up/delivery

Office Pick Up (493 Delaware Ave, Buffalo, NY 14202)

USPS + $8 S&H (mailed directly to the recipient)

Email (digital copy only)

Recipient's Mailing Address (for mailed paper certificate)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Recipient's Email (for emailed digital certificate)

Preferred Payment Method:

Please select how you would like to pay.

Venmo @Amy-Hartl-LMT

Credit Card via digital invoice

Cash (in-office pick up only)

Special Message or Additional Note:

Please share any additional information, questions, or requests, or if you would like to add a special message for the recipient.

Thank you for sharing my work with someone you love!

Gift Certificate Request Form

What You Need to Know

Personalized support and practical self-care strategies for helping breast cancer survivors regain comfort, confidence, and control over their bodies.