Below is the intake form to be filled out for first time massage therapy services.
Please fill out the form and press submit when completed.
Complete and submit the form PRIOR to your session.
Cancellation Policy
We understand that life can be unpredictable, and plans may change. In order to provide the best service to all of our clients and honor the time set aside for your session, we kindly ask that you adhere to the following cancellation policy:
Cancellation Notice: If you need to cancel or reschedule your appointment, please provide at least 24 hours' notice prior to your scheduled time.
Late Cancellations: Cancellations made within less than 24 hours of the scheduled appointment will incur a cancellation fee of 50% of the total service cost. This fee will be charged to the card on file or must be paid before rescheduling.
No Shows: Failure to show up for an appointment without prior notice will result in a charge of 100% of the total service cost. No further appointments can be scheduled until this fee is paid.
Emergency Exceptions: We understand that emergencies happen. If you experience an unexpected situation that requires last-minute cancellation, please reach out to us as soon as possible, and we will handle it on a case-by-case basis.
By checking this box, I acknowledge that I have read, understood, and agreed to the terms outlined above and by booking an appointment, you agree to adhere to this cancellation policy.
Therapeutic Services Only: I understand that the energy therapy services provided are intended solely for relaxation, stress reduction, and holistic well-being. These services are not a substitute for medical diagnosis or treatment and should not be interpreted as such. The therapist does not diagnose, prescribe, or treat medical conditions or illnesses.
Medical Advice: I acknowledge that it is my responsibility to seek professional medical advice from a licensed healthcare provider for any medical concerns or conditions I may have. The therapist will not recommend or prescribe medications or medical treatments.
Communication of Medical Conditions: I agree to fully inform the therapist of any known medical conditions, injuries, or changes in my health status prior to the session. This includes any new diagnoses, surgeries, injuries, or medications.
Changes in Medical History: I agree to notify the therapist immediately of any changes in my medical history or physical condition that may impact my ability to receive energy therapy.
Client Responsibility: I understand that I am responsible for communicating any discomfort or concerns during the session and may request modifications or discontinuation of the treatment at any time.
By checking this box, I acknowledge that I have read, understood, and agreed to the terms outlined above.
Cupping Therapy Waiver and Consent
Cupping therapy, also known as vacuum therapy, is an ancient therapeutic practice that involves placing cups on the skin to create suction. This technique is used to promote blood circulation, relieve muscle tension, reduce inflammation, and facilitate natural healing within the body. Cupping may also help alleviate pain, boost immunity, and improve overall well-being.
Please Note: While cupping therapy has many benefits, it is not a substitute for professional medical treatment or diagnosis. Always consult with a licensed healthcare provider for any medical concerns.
Possible Marks/Discoloration Cupping therapy may result in temporary marks or discoloration on the skin. These marks, often referred to as "cupping marks," are caused by blood being drawn to the surface and typically fade within a few days to a week. These marks are not bruises and do not indicate harm to the body.
Client Responsibilities
Medical Conditions and Medications: I agree to fully inform the therapist of any and all medical conditions, injuries, or medications that may affect my ability to safely receive cupping therapy. This includes, but is not limited to, cardiovascular issues, blood disorders, skin conditions, pregnancy, or recent surgeries.
Communication of Changes: I understand that it is my responsibility to notify the therapist of any changes in my medical history or current health status prior to each session.
By checking this box, I acknowledge that:
I have informed the therapist of any medical conditions, injuries, or medications that may affect my ability to safely receive cupping therapy.
I understand the potential effects, including temporary marks, and consent to the service.
I waive any liability and hold the therapist harmless for any injury or discomfort resulting from cupping therapy.
Inappropriate Behavior Policy
Our practice is committed to providing a safe, respectful, and professional environment for both clients and staff. Any inappropriate behavior, including but not limited to sexual advances, suggestive comments, or inappropriate touching, will not be tolerated. If such behavior occurs, the session will be terminated immediately, and the client may be refused future services. We prioritize maintaining a space of trust, comfort, and professionalism, and expect all clients to uphold these standards during their sessions.
