If you have any health conditions that may prevent you from receiving a massage, you are required to have written permission from your primary health physician before service.
If you are unsure that Massage Therapy is safe for your condition, it is your responsibility to check with your health physician prior to making your appointment.
All information collected from the intake form and any discussion in the office or during treatment will be confidential and never shared with third parties without written permission from the client.
Certificate or Voucher must be presented at the time of service
All massage treatments are for therapeutic purposes only. Any inappropriate behavior (drug use, excessive drinking, illicit or sexually suggestive remarks or advances) will result in immediate termination of the massage session and the client will be charged for the full price of the booked service.
COVID- 19 Protocol
- Wash your hands with soap and water
- Take off shoes before entering practice space
- Sanitizer your hands (we provide an antiviral, hospital-grade hand sanitizer)
- Room is properly ventilated and surfaces will be thoroughly wiped down with 70% proof alcohol wipes before and after treatments
Precautionary Coronavirus Liability Release Form
Due to the 2019-2020 outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below.
Symptoms of COVID-19 include:
- Dry cough
- Difficulty breathing
I, ____________________________ agree to the following:
I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.
I affirm that I, as well as all household members, have not been diagnosed with COVID- 19 within the last 30 days.
I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.
I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days.
I understand that this business and my massage therapist cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.
By signing below I agree to each above statement and release the massage therapist and business from any and all liability for the unintentional exposure or harm due to COVID-19.
Your massage therapist and all employees of this facility agree that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitation protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.
Signature _________________________________________________ Date ____________
By scheduling your appointment you are indicating that you understand and accept these terms and conditions and that you have read and agree to the Covid-19 release/protocol.
If your have any questions or concerns please do not hesitate to contact me.