CedarOak Policy Form

CedarOak Policy Form

Please read, initial, and sign.
Name*

First NameLast Name
Email*
example@example.com
Health History Form
I acknowledge that I have completed my health history form to the best of my ability. Due to the fact that massage/bodywork should not be performed under certain circumstances (a.k.a. contraindications), I agree to keep the massage therapist updated to any changes in my health profile. I release the massage therapist and CedarOak, LLC from any liability if I fail to do so. I understand that any information written or orally exchanged during a massage or bodywork session is held in strict confidence by CedarOak, LLC and is only used to provide the best possible care.

Scope of Practice
I understand that the massage/bodywork I receive is for the purpose of stress reduction and relief from muscular tension, spasm, and to increase circulation. I understand that massage therapists do not diagnose illness or disease or perform any spinal manipulations, nor do they prescribe any medical treatments. I acknowledge that massage is not a substitute for medical examination or diagnosis, and that I should see a qualified physician for these services.

Massage Session
I understand that my entire service includes time for setup and take-down, application of massage, interview, explanation of policy and procedures, assessment, disrobing, redressing, and homecare instructions. The time for the hands-on massage portion of the service is as follows:
1. Cedarwood service: 60 minutes
2. Oak service: 60 minutes
3. Aspen service: 60minutes
4. Royal Palm service: 75 minutes
5. Green service: 75 minutes

Cancellation/Fee Policy
I understand and agree to the fee policy. I also understand that fees are due before or immediately after services are rendered and I am responsible for all payments Notice of cancellation is required 24 hours prior to your appointment. If I cancel within 24 hours and I do not give a reasonable explanation, I will be suspended from scheduling a massage service for 2 months for the first offense, 6 months for the second offense, and permanent suspension for the third offense.
I acknowledge and understand the cancellation fee. Please intial here.*
Pressure
I understand that the massage therapist is committed to providing a professional and safe environment. If I experience any pain or discomfort, I will immediately inform the massage therapist. The massage therapist will then adjust the pressure or methods to my comfort level.
I acknowledge and understand pressure policy. Please initial here.*
Draping/Disrobing
To ensure comfort, modest draping be used for all massage sessions. At no time during the massage will the groin, gluteal cleft, or breast tissue be exposed or touched. Disrobing and redressing is performed privately by the client. The Massage Therapist will not be in the same room during disrobing and redressing and will ask permission to enter the room after the completion of the aforementioned activities. The client has full control over the amount disrobing they choose.
I acknowledge and understand the draping and disrobing policy. Please initial here.*
Consent
I understand I may withdraw my consent for massage at any time, at which point the session will end immediately. I also understand that if the massage therapist has just cause, the massage therapist can terminate the session.
I give my consent to start the proposed massage service, and I understand and agree with all policies listed above. *

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Date
Consent to Massage a Minor

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Minor's Name

First NameLast Name
By my signature, I authorize consent for the above individual to have massage performed by a licensed massage therapist of CedarOak, LLC.

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CedarOak Policy Form

Consent to Massage a Minor