Consent, Agreements and Policies

Application

I hereby apply to receive Soma Structural Integration and/or Somassage® session(s). I understand that the intent of Soma is to help me feel and move better. I understand that Soma is specialized bodywork intended to balance and integrate my bodymind and physical structure. I understand that this work is not a substitute for medical care. 

Soma 11-Series Description: I understand that the standard process of Soma consists of eleven sessions that last 1.5-2 hours each. I understand that neither the Soma practitioner nor I is under any obligation to complete the entire eleven sessions of the Series.

Somassage® or Individual Soma Treatment Sessions Description: I understand that treatment consists of a 1-2 hour session focusing on specific body issues in a wholistic way. 

Consent

I give specific consent to my student practitioner and the faculty of the Soma Institute of Structural Integration to help me establish balance and alignment in my body through touching my body, visually analyzing my posture, and providing movement education strategies. 

By initialing each statement below, I agree to the specific consents required for Soma Structural Integration sessions. I understand that I can revoke the below consents either verbally or in writing at any time. I have received the Notice of Privacy Policy and have been provided an opportunity to review it.

Soma Institute Policies

Risk: I understand the risks associated with Soma Structural Integration include, but are not limited to, superficial bruising, short-term muscle soreness, and exacerbation of undiscovered injury. If I experience any pain or discomfort during a session, I will immediately inform the Practitioner so that the techniques can be adjusted to my comfort level. 

I understand that Soma Structural Integration is not involved with the treatment of diseases of any kind, nor does it substitute for medical diagnosis or treatment when such attention is needed. 

Privacy: I understand that my client file will be retained by the Soma Institute and be reviewed and discussed with the class for instructional purposes only.

Hygiene & Fragrances: I understand that I will be in a classroom with other student practitioners, faculty and bodywork recipients. I will be considerate of the group by showering, wearing unscented deodorant, and taking precautions to minimize body odor. I agree to not wear fragrances on my appointment day because many people have allergies to strong scents.

Masking & Illness: I may be required to wear a face mask if I am at risk of being contagious or have been exposed to someone who is sick. Out of respect for the group, I will wear a mask if there is a possibility of being contagious. I understand that tight fitting respirator masks (N95, KN95) are recommended.

Insurance Billing: I understand that I cannot bill insurance for my sessions. The Soma Institute will not bill any insurance as the work is being done by students, supervised by instructors. 

Late Arrival & No-Shows: I agree to arrive on-time or early to my appointments. Late arrivals and no-shows may not be accommodated or rescheduled.

Cancellations: I understand that because this is an educational setting, it is extremely important for the student practitioners and faculty that I keep my appointment(s) as scheduled. If there is a last-minute emergency or I become sick, I will let my practitioner and the Soma Faculty know immediately. I also agree to communicate  any required change to my appointment time as early as possible.

Payment: I agree to pay the session fee at the time of service.

By signing this document I agree to the conditions as outlined above.

Subject: Somassage® Workshop and Soma Institute Clinic   |    Location: Langley, WA

The Soma Institute occasionally takes photographs of students doing bodywork or participating in lectures to share with students for educational purposes and as a part of marketing the programs, courses and trainings. Photos or video may be of you or your property (belongings). The focus of the video or photography is never intended to be on the person receiving bodywork, but rather on the person(s) performing the bodywork. 

Release: I grant to the Soma Institute, its representatives and employees the right to take photographs and video of me and my property in connection with the above-identified subject. I authorize the Soma Institute, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that the Soma Institute may use such photographs or videos of me without my name and for any lawful purpose, including for example such purposes as publicity, advertising, and web content.

Choose one option—initial below:

I understand that I am required to have certain parts of my body covered either by clothes or linens during a bodywork session. 

Draping Description: Coverage of the body during a bodywork session is known as “draping.” The Washington Administrative Code, WAC 246-830-560, requires proper draping during sessions. Draping requirements involve coverage of the lower body, specifically in the area of the genitals and buttocks, and the breast area.  Bodywork recipients may consent to have their breast area undraped, but the breast area may ONLY be uncovered with explicit consent.

The Soma Institute adheres to the following policies for any clinic or workshop setting:

• Females or those who identify as female will have their chest covered during sessions.
• Males or those who identify as male may consent to be bare chested during sessions.
• Gender non-binary individuals may consent to be bare chested during sessions.

With respect to draping and coverage:

• I understand the need for proper draping during sessions to prevent nudity.
• I understand draping and coverage apply to when I am on the table and when I am standing or walking around as part of the session.
• I understand I am responsible for wearing, at a minimum, an undergarment or shorts on my lower body.
• I understand that for upper body draping, an article of clothing will be used to cover me.
• I understand the Soma Institute may require draping/coverage even if consent is given to be bare chested.

Choose one of the following—initial below:

OR

By signing this document, I agree to the statements and policies above.

Thanks for taking the time to fully complete this form. See ya soon!