Manual Therapy NYC
118 E 37th Street, New York, NY 10016
1.646.417.1837 | https://manualtherapynyc.com | email@example.com
Is there a particular area of the body where you are experiencing tension, stiffness or pain? If yes, please identify: indicate the areas in which you are feeling discomfort:
Payment and cancelation Policies
100% Full Payment is required for the following conditions:
I agree to the Payment and Cancellation Policies above.
Please reschedule your appointment as soon as you are aware of an infectious or contagious condition.
If you arrive for your appointment with symptoms of an illness, you will kindly be asked to reschedule your appointment to avoid the spread of germs. This protects are most susceptible loved ones - children, the elderly, & people with suppressed immune systems, like cancer patients and patients with auto-immune illnesses.
If you have experienced any covid-19 related sympthoms or travel in one one of the restricted states or territories within the last 14 days, call Delia Ahouandjinou before coming to the office.
If any of the following describes you, we kindly ask that you reschedule your appointment or speak direclty with Delia Ahouandjinou so we can prevent the spread of bugs:
Even if you are cancelling your appointment within the 24-hour notice period, the cancellation fee may be waived; the onset of symptoms doesn't always have great timing, right?
I agree to the Sickness Policy above. I understand that if I show signs of infection when I arrive for my appointment, I may be denied access to the office and asked to reschedule my appointment.
By typing my first name, last name, and providing my e-signature below, I am indicating the following:
I understand that Delia Ahouandjinou LMT, CST, does not diagnose illness or disease or other medical, physical or emotional disorder, nor prescribe any medications/treatments. I acknowledge that I am responsible for consulting a qualified physician for any ailments that I may have. If necessary, I allow Delia to discuss with my health care provider the appropriateness of bodywork for my condition.
I have read the New Client Intake Form for Delia Ahouandjinou, LMT CST in its entirety.
I fully understand all questions and information provided in the New Client Intake Form for Delia Ahouandjinou, LMT CST.
I have completed the New Client Intake Form for Delia Ahouandjinou, LMT CST accurately and to the best of my knowledge.
I have read, I understand and I agree to the terms and conditions to receive a session from Delia Ahouandjinou, LMT CST.
I shall take it upon myself to inform Delia Ahouandjinou LMT, CST of any changes.
If I experience any pain or discomfort during this session, I agree to immediately inform Delia so that the pressure and/or methods can be adjusted to my comfort level. The therapist reserves the right to refuse services for any reason of safety.