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. 

Treatment Preferences

Therapy Policies:

Client services and chart information are confidential. Written authorization is required from you to release any information.

• We require a £20 non-refundable* deposit on booking a session
• Please mute or turn off your mobile phone for optimal relaxation
• Your scheduled session is set aside for you. We do not double book appointments
• If you are more than 15 minutes late, we will attempt to reschedule your appointment to a future date.
• 24 hour cancellation notice is required to avoid losing your deposit for a treatment
• You do not need to get undressed for therapy sessions, but loose comfortable clothing (similar to yoga/lounge clothing) is recommended for comfort and ease of treatment
• You will have a consultation with your therapist to discuss your session before beginning
• If we feel something has been raised during a session might benefit from medical treatment we will raise this with the client, or in very limited situations we reserve the right to suggest that medical treatment might be a more appropriate course of action and cancel the session
• The therapist or  client have the right to request to end the session at any time for any reason
• Inappropriate behavior will not be tolerated and may be prosecuted to the full extent of the law

Client Agreement:

I understand the therapist does not diagnose illness, disease, any physical or mental disorder. 

I acknowledge that holistic 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 treatments only as a holistic form of relaxation/therapy, and not as a replacement for medical treatment. I understand that my therapist reserves the right to refuse or end my treatment, if they suspect treatment is being sought instead of essential medical treatment.

I also undersand that at any time I feel anxiety or discomfort during the session, I will immediately inform my therapeutic massage therapist so they can identify need for adaptions, or if appropriate mutually end the session. 

By my electronic signature below, I agree to the Therapy Policy and Client Agreement above.