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Basic Health Information
Consents and Acknowledgments
Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I understand I may be asked for a referral from my primary care provider prior to service being rendered if determined necessary by my therapist.
I realize it is my choice to receive massage therapy. I acknowledge that the treatment is being given for the well-being of my body and mind. This includes stress reduction, relief from muscular tension, spasm or pain, increasing circulation, energy or lymphatic flow, or increasing mobility.
I understand that massage practitioners do not diagnose illness, disease, or any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform spinal thrust manipulations.
I hereby authorize you to release to any physician or practitioner or the practitioner named below any medical or other records or information necessary to provide the best care and collaboration. These records are to be utilized for the coordination of care.
I have been informed of the precautions taken by my therapist to ensure a safe clean environment for my session. I have read the COVID-19 information found on this website. I realize I will be required to answer a series of questions before each session to ensure a safe session for myself and my therapists. I attest that my answers are truthful, trust my therapist to assess all the other clients for safety, and hold harmless my therapist in the event I contract COVID as a result of a session.
I agree and acknowledge that I am responsible for payment of any balance due upon completion of each session unless prior arrangements are made. I understand that emergencies do arise that can result in missing an appointment. Please notify your practitioner as soon as possible if you will miss an appointment. There is no penalty for an infrequent late cancellation or missed appointment. If I fail to cancel two consecutive appointments, I will be responsible for payment of the full fee for both missed appointments prior to rescheduling another appointment.