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Therapeutic Massage Forms

There are 3 forms to fill out here.

Please click submit after each form.

New Client Intake Form - Massage Therapy

Birthday
Month
Day
Year
Are you taking any medications?
Yes
No
Any allergies? (oils, lotions, nuts, fruit etc.)
Yes
No
Are you pregnant?
Yes
No
Due Date:
Month
Day
Year
Are your currently under medical supervision or receiving other medical interventions?
Yes
No
Have you experienced any of these symptoms in the past 6 months? Check all that apply:
History of joint replacement surgery?
Yes
No
Areas of broken skin? (e.g. rash, wounds, scratches)
Yes
No
Recent injuries or medical procedures in the past 2 years?
Yes
No
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Massage Liability Waiver

By signing this form, you agree to the following:


I understand that the massage service offered is for the therapeutic purpose of general wellness, stress reduction, and relief of muscular tension. Information about massage therapy, potential benefits, effects, risks, contraindications, and possible alternative therapies have been explained to me and I understand this information. I understand the risks associated with massage therapy include, but are not limited to:

Superficial bruising

Short-term muscle soreness

Exacerbation of undiscovered injury

I have been given the opportunity to ask questions about massage therapy and my questions have been answered to my satisfaction. If I experience any pain or discomfort, I will immediately inform my therapist so that the pressure or techniques can be adjusted to my comfort level. I will not hold my massage therapist responsible for any pain or discomfort I experience during or after the session.


I have provided my therapist with an accurate and complete medical history and agree to inform my therapist of any new diagnoses, or changes in my health or medications. I do not have any injuries or conditions that prevent me from receiving massage therapy. I understand the importance of informing my massage therapist of all medical conditions and medications that I am taking, and that there may be additional risks based on my physical condition. I understand that I or the massage therapist may terminate the session at any time. I release the massage therapist and business from all liability for any harm that may unintentionally result from this treatment.


I further understand that massage therapy is not a substitute for a medical examination or treatment, and that I should see a physician or other qualified health specialist for any mental or physical ailment of which I am aware. I understand that massage therapists do not diagnose illness or disease, and nothing said during the treatment should be construed as such.

My consent is informed and voluntary and I understand that I may withdraw my consent at any time except for actions already taken.

By signing this form, I agree to the conditions as outlined above, and I release the massage therapist and business from all liability for any harm that may unintentionally result from this treatment.

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Massage Policy Agreement

Client Policies & Guidelines


At The Mend - Integrative Wellness Center, we are committed to providing the highest level of care while maintaining a respectful and professional environment for our clients and therapists. To ensure a smooth and positive experience for everyone, please review our policies regarding appointments, cancellations, and client responsibilities.

 

1. Appointment & Scheduling Policy

All appointments must be scheduled in advance through our online booking system, by phone, or in person. A valid credit card is required on file to secure your appointment.

 

2. Late Cancellation & No-Show Policy

We understand that life happens, and you may need to reschedule or cancel your appointment. However, out of respect for our therapists’ time and other clients in need of care, the following policies apply:

• Cancellations made with less than 24 hours’ notice will be subject to a cancellation fee of 50% of the scheduled service cost.

• No-shows (failure to arrive for a scheduled appointment without notice) will be charged 100% of the service cost.

• If you repeatedly miss or cancel appointments late, we may require prepayment for future services.

To cancel or reschedule, please contact your practitioner or use the online scheduling system at least 24 hours in advance.

 

3. Late Arrival Policy

We strive to provide the full scheduled service time for each client. If you arrive late:

• Your session may be shortened to accommodate the next scheduled appointment.

• You will still be charged for the full session cost, regardless of the actual time received.

• If you are more than 15 minutes late, your appointment may be considered a no-show and charged accordingly.

Please plan accordingly and arrive a few minutes early to ensure you receive the full benefits of your session.

 

4. Card on File Policy

To streamline booking and protect against last-minute cancellations or no-shows, a valid credit card is required to be kept on file. Your card will only be charged in accordance with our Late Cancellation & No-Show Policy unless you choose to use it for payment at checkout.

All card information is securely stored and encrypted to protect your privacy.

 

5. Client Intake Form Policy

For your safety and to provide the best possible care, all new clients must complete a Client Intake Form before their first session. This form gathers important health history and wellness information to customize your treatment appropriately.

• Forms can be completed online before your appointment or in person upon arrival.

• If you do not complete the intake form prior to your session, your treatment time may be shortened to allow for intake completion.

• If you have any updates to your health information, please notify us before your session.

 

6. Massage Termination Policy

Only professional massage and bodywork services for relaxation or therapeutic purposes are offered at this massage practice. Massage services will be terminated immediately in the event of inappropriate conduct of any kind. This includes harassment, threatening speech or behavior, sexual advances or requests, or disrespectful actions or language. A session will not be conducted if the client is under the influence of drugs or alcohol. If the massage is terminated for any of these reasons, full payment for the scheduled session is still required.

 

7. Draping Policy

Clients will be appropriately draped with a sheet and/or towel at all times during their massage. Only areas of the body that are currently being treated will be exposed. The breast and genital areas will always remain draped and are never massaged.

 

These policies are designed to respect the time and commitment of both our clients and therapists. By booking an appointment with The Mend - Integrative Wellness Center, you acknowledge and agree to these terms.

We appreciate your cooperation and look forward to supporting you on your wellness journey!


For any questions, please contact us at themendintegrative@gmail.com


Your signature indicates that you have read, fully understand and will abide by the massage policies as listed above from this date forward.

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Thank You!

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