• The Massage Negotiator Client Liability Form :

    Required by law to massage over the age of 18 (or with separate consent form for massage of a minor), keep progressive reports of clients, protect this information by HIPPA/HIPAA regulations, maintain these client details to prevent massage and bodywork contraindications. An assessment that fully details the modalities and services provided for that session, the appointment date, time of appointment, suggestions for maintaining health and wellness and for your next massage appointment are filled in by your massage therapist and emailed to you after every appointment in 0-7 days (not required by law). You must fill in a new form every 1-2 years for any unforeseen health conditions or limitations you might need to change for your subsequent massage sessions. All massage sessions are customizable and accommodating to any new changes you might experience. After filling out this form you will receive a copy at the email you provided for your records.
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  • Please read the following Terms and Agreements and sign your name after reading each item below about your massage session.

     

  • Terms and Agreements for mobile massage services:

    1. All mobile massage services include the first 1/2 hour drive time from Corona where the 15 freeway and the 91 freeway meet in the historical time marked by Google maps. If you live only 10 miles away, it might not be less than 30 minutes away if it is during a high traffic time that makes the commute 20-45 minutes longer. If your scheduled massage does take longer than the 30 minutes to drive to the massage address or more than 30 minutes on the way back there is a $10/30 minutes fee added to the service or $1/minute.

    2. The correct address must be given to the massage address where the scheduled massage is to be done. If the address is not marked accurately or does not have the building in an apartment complex, the appointment is cancelled for safety concerns and a transportation fee of $20 for the appointment is assessed to the card on file.

    3. Offensive language or body language that is inappropriate and makes the massage therapist uncomfortable or feel disrespected for Title IX basic human protected rights (discrimination for race, religion, gender, sexual preference, sexual identity, disability, age greater than 40 years), or class status, or nationality status, sexually or violently offensive language is not allowed or tolerated. 

    4. Please be ready for the massage 15 minutes before the scheduled time as this is a mobile massage service and traffic can be underestimated, but also time to set up equipment is necessary. If the massage is late up to 15 minutes beyond the scheduled start time and the Google maps history of estimated travel times says it should have been on time from the 91 freeway and the 15 freeway intersection in Corona, CA at the day of the week, holiday, and time, then you get $20 off your massage. Otherwise, if Google maps says the travel distance at that time historically leaving 30 minutes before the start time took longer than 30 minutes, than rule/item 1 above applies to Terms and agreement for mobile massage services. 

    5. If stairs are used in the home address, the lighter massage table that is narrower will be used. If the home address listed appointments has a first floor setting, then the wider massage table will be used, unless anybody in the scheduled appointment household to receive a massage wants a deep tissue massage, then the smaller, lightweight table will be used.

    6. If using any add on services for therapeutic benefits of massage and an electrical outlet is needed to perform the service, such as for infrared light therapy, hot stones, hot towel warmer, table warmer, etc. Then the service can not be provided nor will be charged nor any discount assessed if bundled in a massage promotional package. 

    7. Parking must be available in front of the address, or in the apartment complex, and the distance from the public parking to the massage address will be acknowledged and also time deducted from the allowed 30 minutes delivery of massage supplies to the scheduled massage appointment if the walk is a 10 minute walk for example, and not easily able to be found by building and/or floor number also requiring an elevator. If parking is not available close to or in front of the house, or the street is unsafe or not a wide street that allows cars to park on the sides and two cars able to travel in both directions along the street in front of the house with room and without one car having to stop to wait for the other car to cross before traveling down the street, then the appointment will be cancelled, and a $20 transportation for massage therapist's time will be assessed, plus any estimated transportation and delivery fees if the appointment was realized to be more than 30 minutes to and/or from the scheduled appointment. 

    8. Offensive settings or people in or around the massage therapist providing massage services at the massage address should be zero to minimal and in other room so that nobody bothers the massage therapist while delivering the massage to the guest, or plays with the client receiving a massage while the massage therapist is providing massage such as tickling the person or grabbing the client's body part while said client receives a massage. The massage will be terminated as it is unprofessional and makes the massage therapist feel uncomfortable and is a violation of inappropriate touch during the massage session by a professionally state association for massage therapy licensed, massage standards certification educated, and city of origin business licensed massage therapist. The client will feel uncomfortable and it would be difficult for the client at that time to trust the massage environment is going to be a relaxing one and trust the benefits of massage when another person or guest is distracting the client on the table.

    9. If the client needs to talk on the phone during the massage, it comes from the massage time scheduled, but it is better to schedule a time that fits the client's budget and the time needed and set aside to receive a quiet and peaceful massage.

    10. Pets are allowed to be nearby as long as they don't chew or pee on the massage table or bite the massage therapist.

    11. Time to set up and time to disinfect and put away massage supplies and gratuity is included in all massage appointment prices and packages, if you want to add more for gratuity it will have to be cash.

    12. Only credit card or zelle are acceptable forms of payment for booking and mobile massage services. 

    13. Any massage address booked at a location that is more than 30 minutes of drive time according to Google Maps estimated travel time from the 91 freeway and 15 freeway in Corona, CA is paid for up front.

    14. All massage clients receiving a massage at the massage address have to agree to these Terms and Agreements and fill out this massage client intake form.

    15. You receive a discount of $10 per massage if not in a bundled or packaged massage promotion for filling out the Health intake form for each client before the massage starts for each client. If this is a public event or family massage it doesn't apply.

    16. Any minors receiving a massage must have a form of permission from the legal guardian and/or parent that the minor may receive a massage. Minors may not be able to receive a full hour massage and the parent must be in the room or monitoring the massage in progress start to end. No more than medium pressure will be used, undergarments will be on and the upper thigh and abdomen and chest avoided in the massage of minor by massage therapist.

     

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  • Thank you for filling out your liability and consent to have massage therapy services by The Massage Negotiator. You can save the form now and email janis@themassagenegotiator.com a copy or continue filling out the optional customization of your first massage session on this form. You can also submit it as is if all required fields are filled in by clicking submit below.

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  • Customization of Massage Session for First Time Clients



  • For the below selection, you can find additional information on the requirements for each massage package by visiting: service information.

  • Thank you for your time filling out this form. We look forward to providing you with massage services at your scheduled massage appointment address.

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