Massage Agreement
Please read and acknowledge each section below.
Name
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Which massage therapist are you seeing?
*
Shannon McCluskey
Marta Rodriguez
Kylee Croasmun
Cancellations
: Please cancel with as much notice as possible; minimum of one business day.
No Shows
: A no-show is a failure to arrive for your scheduled appointment and not call to let our team know you won’t be here.
We understand that a minimum of 24 hours notice to cancel/reschedule is not always possible, therefore:
One free no show/late cancellation (less than 24 hours notice) will be granted to each client
Additional no-shows/late cancellations will be subject to a 50% charge of the value of the missed appointment with the credit card on file.
All clients scheduled for appointments will be required to have a credit card on file, but they may choose to pay with a different method of payment when a service is received.
*
Acknowledge
If the massage client is late, the time may be subtracted from the length of the session
*
Acknowledge
If the massage therapist is late, the time will be owed to the massage client.
*
Acknowledge
If the massage therapist discovers any safety concerns, she/he may require a doctor's written approval for massage treatments.
*
Acknowledge
Refunds for prepaid visits will only be provided due to medical contraindication signed by your physician. If a refund is requested, the amount will be calculated based on the value of visits alone, not the discounted bulk rate.
*
Acknowledge
I affirm that I have stated all my known medical conditions and answered all the questions honestly. If there are any changes to your health or medications please let your therapist know.
*
Acknowledge
If you experience any pain or discomfort during your appointments, it is necessary to tell your massage therapist.
*
Acknowledge
Please communicate any questions or concerns with your therapist as they arise.
*
Acknowledge
Please keep in mind that you will get the most out of your massage by taking this time to deep breathe and destress.
*
Acknowledge
I understand that massage/body work should not be constructed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or other medical specialist for any mental or physical ailments.
*
Acknowledge
I also understand that any illicit or sexually suggestive remarks or advances will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.
*
Acknowledge
Understanding all of this, I give consent to receive care.
Client Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: