New Client Intake Form

TO PREPARE YOU FOR A GREAT EXPERIENCE:

• Aromatherapy is complementary with every session. Available scents are lavender, sandalwood, energizing, or fresh linen. If you have a preference, please tell me prior to your appointment.

• Available modalities are relaxation, deep tissue, hot stone, spa, Swedish, therapeutic, & trigger point. 

• You may have a variety of pressure - ranging from light to deep pressure. We will communicate during each session so I may learn your comfort levels and provide the correct amount of pressure. Massages should not cause intense pain or discomfort. Although medium to deep pressure is preferred for effective therapy, please communicate immediately if you experience any tenderness or pain.

• To ensure optimum comfort, please set your air conditioner to a cooler temperature. The room should be cooler than normal because your massage table will be heated. Please inform me if you do not want a heated table.

• You may disrobe to your level of comfort. Proper coverage of your body will be maintained at all times.

• You should not drink alcohol before or after a massage, as this may increase dehydration, make you dizzy, cause nausea and/or vomiting.

• When receiving a massage, toxins are released from the muscle tissue into the bloodstream. For this reason, it is very important to flush your system by drinking plenty of water after your session.

• If you have a cold, flu, or fever, massage will make your illness significantly worse. If you are exhibiting symptoms, I cannot provide massage services.

If you complete the electronic intake form, you agree to the following terms with informed consent:

1.  I understand that the massage given is for the purpose of relaxation, stress reduction, pain reduction, relief from muscle tension, increasing circulation, and/or therapeutic care.

2.  I understand that the massage therapist does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage therapy.

3.  I understand that massage therapy is not a substitute for medical care and that it is recommended that I work with my primary caregiver for any condition I may have.

4.  I have stated all my known physical conditions and medications, and I will keep the massage therapist updated on any changes.

5.  I will not hold the massage therapist responsible for any personal injury or damage/loss of property.

6.  I waive any right to future litigation or compensation based on massage therapy services received.

7. I indicate informed consent for massage therapy. I read or downloaded a copy of the HIPAA disclosure sheet

SITE MAP

• Home page 

• Personalized therapy

• Rates & schedule

• Types of massage

• Custom requests 

• New client intake form 

• HIPAA disclosures