Patient Intake

COVID-19 SYMPTOMS

Please check the box below if any of the following are true:

• Have had a fever within the last 24 hours

• Recently experienced respiratory/flu symptoms, sore throat, or shortness of breath

• Contact, within the last 14 days, with anyone diagnosed with COVID or related symptoms

Client Waiver Form

Please take a moment to read and initial the following information:

• I understand that massage therapy is intended for relaxation, stress reduction, relief of muscle tension, and improved circulation and energy flow.

• If I experience discomfort or pain at any time, I will inform my therapist immediately so adjustments can be made. I will not hold the therapist responsible for discomfort experienced during or after the session.

• I understand that massage therapy is not a substitute for medical care. My therapist does not diagnose, prescribe, or treat medical or mental health conditions, nor perform spinal or skeletal adjustments.

• I acknowledge that chair massage is not a substitute for prenatal care. I understand that my therapist does not provide prenatal massage. If I become pregnant or begin trying to conceive, I will notify my therapist within 24 hours. I understand the therapist may decline service, and cancellation policies still apply.

• I confirm that I have not consumed alcohol within the past 24 hours and will not schedule a session if I plan to consume alcohol within 24 hours prior. I understand the therapist may refuse service and that appointments are non‑refundable.

• I affirm that I have disclosed all known medical conditions and injuries.

• I agree to inform the therapist of any changes in my health. I understand the therapist is not liable if I fail to do so.

• When scheduling a massage, the client acknowledges and understands the following terms:

• The client acknowledges and understands that if a refund is requested from the massage therapist, the $3.85 convenience fee is non‑refundable. This fee is charged directly by the scheduling software and cannot be reversed.

• If the client cancels their appointment less than 24 hours before the scheduled time, the payment for the session will not be reimbursed. This policy ensures fairness and protects the therapist’s time and availability.

• All participants must be 18 years of age or older to receive a massage. If a minor is receiving a chair massage, the custodial parent or legal guardian must sign the waiver and remain present for the entire duration of the session.

• I understand that massage is strictly therapeutic and non‑sexual in nature. Any sexual misconduct will result in cancellation of session, removal of client and non-refundable.

• By signing this form, I waive and release the therapist from any liability, past, present, or future, related to massage therapy or bodywork. By booking an appointment, the client confirms their understanding and acceptance of these terms.