Client services and chart information are confidential. Written authorization is required from you to release any information.
• Please turn off your cell phone for optimal relaxation
• Your scheduled session is set aside for you. We do not double book appointments
• Please reschedule your session if you are more than 15 minutes late
• 24 hour cancellation notice is required to avoid being charged for your session
• You will be draped and at no time will genitalia or breast tissue be exposed
• You will have a consultation with your therapist to discuss your session
• Should the session require, after your therapist has left the room, you may disrobe to your comfort level
• I understand that my therapeutic massage therapist or I may end the session at any time for any reason
• Inappropriate behavior will not be tolerated and may be prosecuted to the full extent of the law
It is my choice to receive massage or Health Consultations as a form of therapy. Due to Covid 19 I am aware of the benefits and risks of being treated in this office and give my consent for treatment / consultation . I take full accountability of my immune function knowing others are treated and sharing this healing space. __________ (initial here if in office)
I have stated that I am free of any symptoms of flu illness, cold symptoms , and or symptoms of covid 19 with no fever. To my understanding I have not been in contact with anyone with Covid 19 within the last 2 weeks or 14 days. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis.___________ (initial here if in office)
I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status.
I understand that my personal health information will be collected. I understand that all information that I provide will be kept on record and file 3 years or unless required by law. I understand and consent that my medical information may be shared by the various careproviders involved in my care and treatment.
I understand that therapeutic massage therapists do not diagnose illness, disease, any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform joint mobilization.
I understand that treatment given is designed to address the care and prevention of myofascial pain management, dysfunction along with Lymphatic, Swedish, Ayurvedic and Other modalities of the healing arts.
I also undersand that at any time I feel pain or discomfort during the session, I will immediately inform my therapeutic massage therapist so they adjust.
I have stated my pertinent medical conditions, and will update the massage therapist of any changes in my health status.
I understand that my failure to do so may post a threat to my health and/physical well being and I do not hold Hanusa Msssage Therapy and my therapeutic massage therapist from any liability whatsoever arising from failure on my part.
By my electronic signature below, I agree to the massage policy and client agreement above.