• BODI'OASIS

    3095 Marshall Hall Road

    Bryans Road, MD 20616

     

    Massage Client Intake Form

    All information is held strictest confidence. At no given point is information disclosed or shared without client’s written consent. You may choose to skip answering any question you feel impinges on personal information you do not wish to disclose. 

  •  -  - Pick a Date
  • prev next ( X )












    Total   $ 0.00
  • *COVID RESPONSE/TRACKING

    In the past 14 days have you experienced any of the below? If the answer is YES to any-PLEASE RESCHEDULE YOUR APPOINTMENT 14-20 days out

  •  
  • History of Pathology-

    Not only are massages soothing, relaxing, and theraputic, but massages are used to address specific pain points and in some cases medical concerns. 




  • Please check any symptoms that apply to you and indicate right or left when applicable:








  • Massage Policies:

    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. 
    • Deposits will not be refunded for no show appointments. 
    • Please be on time to maximize your service.  
    • 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
    • You understand that your massage therapist or you may end the session at any time for any reason
    •  Inappropriate behavior by either the client or the therapist will not be tolerated and may be prosecuted to the full extent of the law

    Client Agreement:

    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 acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that a physician be seen for that service.

    It is my choice to receive therapeutic massage as a form of therapy.

    I understand that treatment given is designed to address the care and prevention of myofascial pain and dysfunction.

    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 hold harmless Bodi'Oasis Wellness Spa and Salon, a division of Bodi'Naive Skincare, LLC 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. 


  • Clear
  • Should be Empty: