• The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • Client Intake Form

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  • The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • Medical History

  • The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • TMJ & Musculoskeletal Questionairre

    This information will maximize the safety and effectiveness of your evaluation and/or treatment. Your answers and selections will be the building blocks to your treatment plan on the first and follow-up visits. Please carefully take your time filling out this information. Below, make selections that apply to you.
  • The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • TMJ & Musculoskeletal Questionairre (Continued)

  • The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • TMJ & Musculoskeletal Questionairre (Continued)

  • General Musculoskeletal Questionairre

    Check all that apply.
  • The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • Client Informed Consent

  • 1) I give permission to receive massage & bodywork therapies.

    2) I understand that therapeutic massage is not a substitute for traditional medical treatment.

    3) I understand that the massage & bodywork therapist does not diagnose illness or injuries or prescribe medications.

    4) I have clearance from my physician to receive massage therapy.

    5) I understand the risks associated with massage and bodywork therapy include, but are not limited to:

    ·         Superficial bruising

    ·         Short term muscle soreness

    ·         Exacerbation of undiscovered injury

    6) I understand the importance of informing my therapist of all medical conditions and medications I am taking, and to let the massage therapist know about any changes to these. I understand that there may be additional risks based on my physical condition.

    7) I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the massage session so she can adjust accordingly.

    8) I understand that I or the therapist may terminate the session at any time.

     

    By my electronic signature below, I agree to the Informed Client Consent Form.

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  • The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • Payment Policy

    • Payment for treatment is always collected before the session begins.
    • Accepted payment methods are Venmo, Zelle, HSA, and cash.
    • $190.00 is due at the time of Initial Visits and at Follow-Up Visits.

     

    By signing below, I agree to the Payment Policy.

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  • The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • Short Notice Cancellation Policy

  • We know your time is valuable, and ours is too. Out of respect for our staff and our other clients, we ask that you give us at least 24-48 hours of notice if you need to cancel an appointment. The sooner the better. Please leave a message at 848-444-1626 at any time to notify us if you need to cancel or reschedule. Text messages are welcome.

     

    ·  Appointments cancelled without atleast 24 hours notice will incur a $80 cancellation fee that must be paid prior to your next visit.

     

    · If someone books and shows up for treatment during the time block of your missed appointment that day, you will be refunded the $80 cancellation fee.

     

    By my electronic signature below, I agree to the Short Cancellation Policy.

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  • The Jaw Remedy

    Advanced TMJ Massage, Bodywork Therapies, & Self-Care
  • Late Policy

  • Out of respect for everyone to be seen at their scheduled time, we have created this late policy. 

     

    ·  If you are x amount of minutes late, that will be x amount of minutes less during your treatment session.

    · We will always try to accomadate the full length when possible, for example, if there is enough time between the next scheduled appointment.

    · The price of the treatment will remain at full price.

    By my electronic signature below, I agree to the Late Policy.

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