Client Intake Form
In Case of Emergency, Please Notify
Massage Therapy Informed Consent
understand that massage is intended to
enhance relaxation, reduce pain caused by muscle tension, increase range of motion, improve
circulation and offer a positive experience of touch.
The general benefits of massage, possible massage contraindications and the treatment
procedure have been explained to me. I understand that massage therapy is not a substitute for
medical treatment or medications, and that it is recommended that I concurrently work with
my Primary Caregiver for any condition I may have. I am aware that the massage therapist does
not diagnose illness or disease, does not prescribe medications, and that spinal manipulations
are not part of massage therapy.
I have informed the massage therapist of all my known physical conditions, medical conditions
and medications, and I will keep the massage therapist updated on any changes.
Cancellations:Your business is valued and your cooperation is appreciated .We are making a commitment to you to guarantee your appointment time and refusing all other requests once you have made the appointment. A 24-hour cancellation notice is required for any scheduled appointments including gift certificate sessions. Missed or no-show appointments will result in your being charged the full amount of the session booked unless the appointment can be filled. Depending on our booking schedule, late appointments may not receive the full session time allotted for the treatment service booked: Full payment is required.. Emergency cancellations are determined by the Massage Therapist discretion.
924 Buffalo Manitowoc, Wisconsin 54220 | 920-684-8880 | email@example.com