I have completed this form to the best of my knowledge. I understand that Massage Therapy and Bodywork services are a therapeutic health aid. I understand that massage therapy does not diagnose illness or disease and that my massage therapist does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations a part of massage therapy.
Second I understand that massage therapy is not a substitute for medical examination or medical care, and that it is recommended that I concurrently work with my primary caregiver for any condition I may have. I also understand that it is required that I adhere to any medical prescription and advice of my primary caregiver in order to receive massage therapy.
I understand that if I am not able to make a scheduled appointment, I must cancel the appointment by phone at least 24 hours in advance, unless I have an emergency. If I have an emergency, I will call as soon as possible to reschedule my appointment. If I give less than a 24-hour notice (but more than 3 hours), I agree to pay 50% of the appointment fee. If I give less than a 3-hour notice, or if I do not show, I agree to pay 100% of the appointment fee. If I am late to an appointment, I agree to pay the full amount of the appointment that I initially scheduled and I may not get the full time originally scheduled due to another client after me.
I have provided, on this form, all known medical conditions, physical conditions, and medications, and agree to keep my massage therapist updated on any changes.
I understand that I may be denied services if I behave inappropriately during the session, if I have consumed drugs or intoxicating substances prior to my session, if I have missed 3 or more appointments without giving 24-hour notice, or if I am not adhering to the medical prescription and advice of my primary caregiver.
Additionally, I agree that if I take any steps to make a claim for damages against MuscleMind, LLC, its agents, employees or any other released parties arising out of my receipt of services during my appointment, I shall be obligated to pay all attorneys’ fees and costs incurred as a result of such claim.
