Pantera Massage

Client Intake / Consent Form

 

It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage. 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. 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 confidential unless required by law. I understand and consent that my medical information may be shared by the various care providers involved in my care and treatment.

1. Cancellations/No-Shows

When an appointment is cancelled or missed without providing at least 24 hour notice that appointment time often does not get re- booked.

This puts a strain on my schedule as most clients cannot change their plans last minute to fill these times.

Cancellation fees are as follows:

less than 24 hours - 50% of service

no-call no-show - 100% of service

 

The card on file will be utilized to process any applied fees. If the card on file declines, you will not be able to book any future appointments without correcting it. These fees are to cover my time & resources so that I can continue to serve you.

I understand that emergencies arise & illnesses occur at inopportune times. Please let me know the reason for your cancellation as I do my best to keep these things in mind. The fees will not transfer to any future appointments.

2. Late Arrivals

I do not apply late fees, however, please be advised that your session will be reduced by the amount of minutes you are late. This means that the session will still end at the same time it was scheduled to end. If you are more than 15 minutes late, there is a possibility that the appointment would have to be rescheduled. This is to ensure that the following appointments do not fall behind schedule. If you are running late, please provide notice as you will be considered a no-call, no-show if I have not heard from you within 10 minutes from the start of your appointment.

Massage therapy is for therapeutic purposes only. There is absolutely no sexual component to massage under any and all circumstances.

 

Any sexually suggestive remark, insinuation, joke, gesture, conversation or request otherwise will result in immediate termination of vour session as well as refusal of any and all services in the future, and a report to be filled with the appropriate law enforcement offices (s). Immediate termination of the session will ensue if the you engage in illicit drug use, excessive drinking and/or other inappropriate behavior.

 

You will be charged with a $500 IBP Fee and the full service fee plus 50% gratuity regardless of the length of your session.

 

Treat your therapist with respect and you will be treated the same in return.

GENERAL CONDUCT

All massages are for therapeutic purposes only.
All clients must complete a consultation form prior to treatment and will receive a brief consultation as part of their treatment.
Treatments will only be conducted if therapist deems the treatment safe for the client to receive.
Immediate termination of the session will ensue if the customer engages in illicit or sexually suggestive remarks, sexual advances, drug use, excessive drinking and/or other inappropriate behavior.
If the session is terminated due to the customer's inappropriate behavior, the customer is
responsible for payment in full and his/her credit charge will be processed.

APPOINTMENTS

• Management reserves the right to cancel or reschedule appointments based on inclement weather or unforeseen circumstances.

We commit to providing treatments within two weeks of the canceled treatment where possible.

• Pantera Massage has the right to cancel a treatment without notice if the client is intoxicated or inebriated.

PAYMENT

We accept most major credit cards (Visa, MasterCard, Discover, American Express) personal checks, and cash.
We do not accept any form of insurance.
PRIVACY

• Client treatment details will not be discussed

with anyone other than the client unless the client is under the age of 18 or has a care worker or guardian.

Consultations will only be discussed with the client unless the client is under the age of 18 or has a care worker or guardian.
Every client must complete an intake form prior to receiving treatment.

By signing the Intake forms, clients are giving
Pantera Massage permission to hold records and data concerning the person.
All intake and treatment notes will be kept securely on file.
Personal information will not be shared with any third party.
CLIENTS WHO ARE MINORS

Clients under 18 years of age must be accompanied by an adult.
The adult must give permission for the treatment to be performed, along with co-signing the Intake form.
The adult must be present in the room throughout the treatment.
COMPLAINTS PROCEDURE

If a client wishes to make a complaint about
Pantera Massage, this must emailed to alesan.mt@gmail.com
Complaints must include the date, location of the incident, the full name of the complainant, details of the complaint and a desired outcome.
All complaints will be taken very seriously and a response will be provided within 30 davs.
UNDERSTAND AND AGREE TO THE

FOLLOWING:

Massage is not a substitute for a medical examination or for treatment. I am responsible for

seeking the advice of a physician, chiropractor or other qualified medical specialist for any mental and or physical ailments. I will disclose to the massage therapist all known medical conditions before the massage session. I will keep the provider(s) updated as to any changes in my medical profile. I understand that there wil be no liability on the part of Pantera Massage or the individual massage therapist (Aleiandra Sandoval, LMT) if I fail to disclose any new or updated medical issues.

o l am at least 18 years old and I am booking an appointment for myself or someone else who is at least 18 years old. As an adult, understand my responsibilities as well as the risks as described in the terms and conditions. o All appointments must be made directly through the Pantera Massage LinkTree or Instagram page by using the "BOOK NOW" button.

o Pantera Massage is not responsible for any personal injury or property loss as a result of a massage therapy session. Our massage therapist holds their own liability insurance and are responsible for their conduct and practice. In the event of a claim, please notify both the massage therapist and Pantera Massage. o Pantera Massage has the right to refuse service at any time without recourse.

o Pantera Massage has the right (but not the obligation) to delete or deactivate any account or terminate access to or use of the service or any part thereof), immediately and without notice. Pantera Massage has the right to remove and discard any content within the service, for any reason. Further, I agree that Pantera Massage shall not be liable to me or any third-party for any termination of my access to the service.

o Pantera Massage reserves the right, at our sole discretion, to change, modify or otherwise alter these terms and conditions at any time.

Such modifications shall become effective

immediately upon being posted on the Pantera

Massage website. I understand that it is my responsibility to review the terms and to keep current on them. If I disagree with the terms, I am not obligated to use the service.

Furthermore, agree to indemnify and hold Pantera Massage, its officers, subsidiaries, affiliates, successors, assigns, directors, officers, agents, service providers, suppliers and employees, harmless from any claim or demand, including reasonable attorney fees and court costs, made by any third party due to or arising out of content I submit, post or make available through the service, my use of the service, my violation of the Terms and Conditions, my breach of any of the representations and warranties herein, or my violation of any rights of another.

I agree to ALL of these terms and conditions, and I understand that they apply to all services performed by Pantera Massage.