Massage & Bodywork

Name *

First Name

Last Name

DOB *

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Phone *

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Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone Number *

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Please indicate the following that apply to you: *

Cancer

Headaches/Migraines

Arthritis

Diabetes

Joint Replacement(s)

Fibromyalgia

Stroke

Heart Attack

Blood Clots

Numbness

Depression/PTSD/Anxiety

Neuropathy

Strains/Sprains

High Blood Pressure

Low Blood Pressure

IBS

Hernia

Heart Conditions

Osteoporosis

None of the above

Payment Method Policy *

All prices that are shown on this website reflect a cash price. If you would like to pay via venmo, credit card, etc. a convenience fee will be applied at checkout. -Please be aware that if credit card strips are not working and the card number needs to be typed in, this is the highest convenience fee percentage.-

I have read, understand and agree to the payment method policy

Proper Hygiene Policy *

I hold the right to refuse services to any client due to poor hygiene and or anything contagious (examples: warts, skin rashes, virus/flu symptoms). If a client attends a session while carrying a contagious skin condition, whether knowingly or unknowingly, resulting in the cessation of the session due to the contagious nature of the disease, they will still be responsible for the full cost of their session. To prevent such occurrences, prior to scheduling an appointment, a thorough review of the intake form is conducted to identify and address any potential health concerns. Please be mindful to have showered within 24 hours of your bodywork/massage session.

I have read, understand and agree to the proper hygiene policy

Late Arrival Policy *

Late Arrivals To ensure that we have enough time to address your areas of focus and answer any questions you may have, please arrive 10 minutes prior to your scheduled appointment. Please be advised that a late arrival will result in the session ending at the scheduled time. Additionally, you will be responsible for the full amount of the session. As a courtesy to our other clients, I have reserved your time slot exclusively for you and have other appointments scheduled after yours.

I have read, understand and agree to the late arrival policy

Cancellation Policy *

Cancellation/Reschedule/No show policy I understand that unforeseen circumstances occur from time to time. To ensure fairness to all clients and ourselves, as massage therapists, I kindly request that you provide us with a 24-hour notice if you need to cancel a session. In the event that you need to cancel and reschedule your appointment, there will be no fees charged for the cancellation, as long as you have scheduled a future appointment. Please note that this policy only applies in cases where the cancellation and rescheduling does not occur frequently. However, if cancelling and rescheduling becomes a regular occurrence, a 50% deposit will be required to hold any future appointments. To ensure that my services are available to all clients, I have implemented a strict cancellation policy. Please note that cancellations made via phone call or text with less than 24 hours notice will result in a 35% invoice of the session fee. This invoice is due on the day of the originally scheduled appointment, and further appointments will be denied until payment is received. Please be aware that email is not an acceptable form of communication for cancellations. To ensure that my business runs smoothly, I have a policy in place for missed appointments. If a client fails to show up without prior notice, they will be charged 100% of the session fee and future appointments will be refused until the payment is made. If there is a credit card on file, that card will be charged 10 minutes after your scheduled appointment if there is no response to my text and the appointment will be terminated. In the future, I will require an 80% deposit to secure any bookings. If you have a pre-paid package or gift certificate and do not show up, the session will be forfeited.

I read, understand and agree to the cancellation policy

Signature *

By signing below you agree to the following: * I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow. * If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session. *I understand that stretches and traction can result in unexpected adjustments in the body and can also cause emotional release. If I experience emotional releases I will inform my therapist so they can take the proper steps to form a comforting and safe environment. * I understand that the services offered today are not a substitute for medical care. I understand that my therapist is not qualified to diagnose, prescribe, or treat physical or mental illness. * I affirm that I have notified my therapist of all known medical conditions and injuries. * I agree to inform the therapist of any changes in my health and medical condition. I understand that there shall be no liability on the therapist’s part should I forget to do so. * I understand that massage is entirely therapeutic and non-sexual in nature and any sexual remarks or advances will terminate the session at full cost without refund. * I understand that, because massage therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. * By signing this release, I hereby waive and release my therapist from any and all liability, past, present, and future relating to massage therapy and bodywork.

First Name

Last Name

Date *

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