Crazy Beautiful Spa Massage Intake

*You must be more than 12 weeks pregnant with a low-risk pregnancy to receive a prenatal massage**

I agree

Full Name*

First NameLast Name

Date*

MonthDayYear

Phone Number*

Area CodePhone Number

E-mail*

How did you hear about us?*

Do you have any allergies? If yes, please list them, if none please write NONE*

Are you taking any medication? If yes, please list them., if none please write NONE*

Are you experiencing any of the following:*

Do you or have you ever experienced:*

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

• Please turn off your cell phone for optimal relaxation

• Your scheduled session is set aside for you. We do not double book appointments

• We will reschedule your session if you are more than 15 minutes late

• 24 hour cancellation notice is required to avoid being charged for your session

• You will be draped and at no time will genitalia or breast tissue be exposed

• You will have a consultation with your therapist to discuss your session prior to your massage

• Should the session require, after your therapist has left the room, you may disrobe to your comfort level

• I understand that my therapeutic massage therapist or I may 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 that therapeutic massage therapists do not diagnose illness, disease, any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform joint mobilization.
I acknowledge that massage 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 therapeutic massage as a form of therapy.
I understand that treatment given is designed to address the care and prevention of myofascial pain and dysfunction.
I also undersand that at any time I feel pain or discomfort during the session, I will immediately inform my therapeutic massage therapist so they adjust.
I have stated my pertinent medical conditions, and will update the massage therapist of any changes in my health status.
I understand that my failure to do so may post a threat to my health and/physical well being and I hold harmless Crazy Beautiful Spa and my therapeutic massage therapist from any liability whatsoever arising from failure on my part.

By my electronic signature below, I agree to the massage policy and client agreement above.

Signature*

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