Massage & Chill Sessions

Welcome!

This is an Introverted Self-Care Studio. Our goal is to make the spa environment inclusive to more introverted personalities, those with social anxieties, and people who prefer a high-value, low-stress relaxation experience.his ensures I prepare everything for your comfort prior to your session. Your appointment will not be accepted if the intake form isn't filled out before the session.

ASMR Massage Sessions (optional)

ASMR Treatments are focused on your back, scalp, or face. Choose 3 tingles for a completely customized experience. Enjoy 15 minutes of deeply soothing, personalized attention, baked right into your service.

Facial & Massage Intake Sections

Interested in a facial? Fill out the facial section.
Booking a massage? Complete the massage section.

Thinking about both? Save time and complete the entire form now so you won’t have to later!

What to Expect on Your First Visit:

- You'll receive a text confirmation after submitting this form
- I'll greet you and show you to your private treatment room
- You'll have privacy to undress to your comfort level and settle onto the table/chair
- I'll knock before entering
- After your session, take your time getting dressed - no rush
- Your post-session preference will be honored (you'll select this later in the form)
- Payment is handled through Square Appointments, so no awkward checkout
- All first-time client sessions are 45 minutes.

I look forward to working with you. ~ Golden Jaye LMT, LE
Client Intake Form
Full Name*

First NameLast Name
Preferred Name/ Nickname
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Birthday

MonthDayYear
Date
Emergency Name, Contact Info & Relation to Client*
Preferred method of contact

TextCallEither is fineEmail is preferred
How did you hear about us?

Google searchInstagramYouTubeFriend/Family referral
Other:

Any other specific days work for you session, if your ideal date & time doesn't work.

MonthDayYear
Date
Hour MinutesAM/PM Option
Would you like to be notified about promotional services?

YesNo
Health Information
Are you currently under the care of a physician or receiving any medical treatment? *

YesNo
If yes, please provide details: If yes, please provide details:
Are you currently taking any medications?☐ Yes☐ No

YesNo
If yes, please list:
Are you pregnant or breastfeeding?

YesNo

Massage Therapy Services (only fill out if interested in massage services)
Have you had a massage before? If yes, what type of massage did you receive and when was your last session.
What is your primary reason for seeking massage therapy today?
Do you have any specific medical conditions or allergies we should be aware of? (e.g., heart conditions, allergies to certain products):
Do you have any areas of discomfort, tension, or pain you'd like me to focus on?(Examples: neck, shoulders, lower back, legs, etc.)
Do you have any areas that you would like the therapist to avoid? If so, which areas?
Pressure Perference

Skincare / Facial Massage (Only fill out if interested in skincare services)
Have you had a facial before?
If yes, when and where was your last facial?
What are your primary skincare concerns and goals?(Examples: acne, anti-aging, hydration, hyperpigmentation, sensitivity, etc.)
What skincare products are you currently using? How long?
Have you had any adverse reactions to skincare products, previous facial procedures (botox/ filler, etc), or other ingredients in the past?
Are you open to finding a new routine or product?

SECTION 9: Additional InformationIs there anything else you'd like me to know?(Examples: past injuries, social anxieties, neurodivergence, sensory sensitivities, past negative spa experiences, triggers to avoid, anything that helps me serve you better)
Speak now or forever hold your peace.
Consent, Policies & Agreement

Studio Policies
My aim is to provide an atmosphere of relaxation and stress relief. To maintain this ambiance, we have established certain rules and policies to ensure a seamless experience for all clients.

Payment and Booking Policy:
We do not operate with late fees or deposits; however, prompt payment is essential. Payments must be made in full by 9 am on the day of your scheduled service. Failure to do so will result in the forfeiture of your session. Clients are allowed one-time leniency for missing payment deadlines or being up to 10 minutes late. Subsequent violations will result in a three-month booking suspension.

Intake Form Policy:
All appointments require a completed intake form at least 24 hours prior to your scheduled session. Appointments without completed intake forms will be automatically canceled. This policy helps us prepare your personalized experience and maintain our peaceful, organized environment.

Punctuality and Respect for Time:
We prioritize a stress-free environment by adhering to scheduled appointment times. Being late disrupts the calm atmosphere and the intended relaxation process. As such, we strictly enforce our punctuality policy.

Our Commitment to Timekeeping:
In the event of any unforeseen delays on our end, we value your time and understand its importance. For every 10 minutes we are late, you will receive a $5 discount off the service cost.

HIPAA Compliance and Client Confidentiality:
Your privacy is of utmost importance to us. We adhere to HIPAA regulations and ensure the confidentiality of all client information. Medical details provided in this form must be accurate at the time of signing. Golden Relaxation Studio is not responsible for any lack of or misinformation not included in the form, including allergies and current medications/contraindications. We also work within our scope of practice and may postpone treatment if your needs require outside medical attention.

Photography and Media:
We do not film or take photos without your consent. Before & After pics are required for facial treatments to show personal growth, but those photos will NOT be on any of our social media platforms.

Final Notes:
By abiding by these policies, we strive to create an environment conducive to relaxation and wellness for all our valued clients. Your cooperation is appreciated and helps us maintain the welcoming atmosphere as an introvert-friendly self-care studio.

Your submission of this application is your confirmation of understanding and acceptance of our policies.

Applicants will receive a response within 36 hours or less.

Thank you for entrusting us with your well-being.

Warm regards, Golden Jaye LMT, LE

Your solitude is our priority. 🤍
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