Body Language Relaxation spa

Client_

DOB

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Email Address

example@example.com

Relaxation, stress reduction

Please answer the following questions to ensure a comfortable and safe massage. What is your primary goal for this massage? (Check all that apply)

Relaxation, Stress ReductionRelieve muscle tensionGeneral Health and well being

Other, please specify,

Have you had any illness, accidents, or injury recently? If yes, please explain briefly

Are you experiencing any of the following today? Check all that apply

For women. Are you pregnant?

YesNo

Do you have any allergies, especially to oils, lotions, peanuts or latex?

YesNo

Have you taken any medications today?

YesNo

If so, Please list:

I have answered the above questions to the best of my ability. I acknowledge that massage therapy does not include medical diagnosis and that I should see an appropriate health care provider to diagnose and treat medical problems. I give my consent for the massage session.

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Body Language Relaxation Spa Policies

1. Massage sessions are available by appointment only.

2. Payment is due at time of massage appointment.

3. Payments must be made with cash or credit card.

4.Appointments are reserved for the time slot chosen. Clients arriving late for their appointment will receive massage as possible during the remainder of their reserved time.

5. There is a 24 hour cancellation policy. Clients will be charged for missed appointments.

6. Client records are kept secure and confidential (See Privacy Policy, below)

7. Clients are expected to exhibit good hygiene and are asked to minimize the use of perfume, cologne, and heavily scented personal products.

8. The use of cell phones is not allowed during the massage session. Please silence or turn off all phones while in the building.

9. Massage sessions may be terminated at any time if the massage therapist has any reason to believe that the client is sexualizing the massage, or uses inappropriate or threatening language or behavior.

10. This office follows the Code Of Ethics and Standards of Practice of the American Massage Therapy Association.

Privacy policy

Your massage therapy records are kept in the strictest confidence by this office. All client records are kept in a secure place, and only those who need to see client's files for legitimate business, or professional purposes have access to them. Your records will not be released to third parties, including health care providers and insurance companies, without your written consent. Records may be surrendered if required by law.

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