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  • Massage Therapy Intake and Consent Form

    Please read all updated policies and guidelines, updated : 7/30/25

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Policies & Client Guidelines

    Please read all the way through before signing. 

    Informed Consent for Massage Therapy

    Massage therapy is a therapeutic treatment involving the physical manipulation of the soft tissues of the body. I understand that:

    Massage therapy is not a substitute for medical care, diagnosis, or treatment by a licensed healthcare provider.
    Massage therapists do not diagnose conditions, prescribe medications, or treat injuries or illnesses outside the scope of massage therapy as defined by the Utah Division of Occupational and Professional Licensing (DOPL).


    It is my responsibility to inform my massage therapist of any pre-existing conditions, medical concerns, injuries, or changes to my health prior to each session.
    Soreness, tenderness, or minor bruising may occur after a session. If I experience unusual pain or discomfort during or after the massage, I will inform my therapist immediately.


    I have the right to decline or stop any part of the session at any time, for any reason, without penalty.


    My therapist will maintain appropriate draping and professional boundaries at all times to ensure comfort, privacy, and dignity.

    Client & Professional Boundaries

    All massage sessions are strictly non-sexual.
    Any inappropriate, suggestive, or disrespectful behavior will result in the immediate termination of the session. Full payment will be required, and future appointments may be declined at the therapist’s discretion. Harassment or threatening behavior may result in law enforcement involvement.

    Gift Policy

    While tipping is never expected, some clients choose to express appreciation through gifts. These may be accepted at the therapist’s discretion. However, gifts that feel overly personal, emotionally intimate, or that blur professional boundaries will be respectfully declined. This policy helps maintain a safe, comfortable, and ethical environment for all.

    Scheduling & Cancellation Policies

    No deposit is required to book at this time, but this may change if needed in the future.
    Cancellations require 24-hour notice. Cancellations with less than 24 hours’ notice will result in a $25 fee to continue booking in the future.
    No-shows: After three no-shows, booking privileges will be revoked. A $25 fee will be charged for each no-show if you wish to rebook.
    Late arrivals: If you arrive more than 15 minutes late, your session will need to be rescheduled and a $25 rescheduling fee will apply. If a late start is accommodated, the session will be shortened to end on time, and the full session fee will still apply.

    Minors

    Clients must be 18 years or older to book on their own.
    Minors must have a parent or guardian sign a consent form and be present during the entire session.

    Privacy & Confidentiality

    Your personal and health information is kept confidential and secure in accordance with Utah law and applicable federal privacy rules.
    While most massage therapists are not considered HIPAA-covered entities, your therapist follows strict confidentiality practices. All client records and information will be kept private and only shared with your written consent or as required by law (e.g. abuse reporting or court orders).

    Licensing & Ethics

    Your therapist holds a valid Massage Therapy License in the State of Utah and abides by all laws, rules, and the Code of Ethics set forth by the Utah Division of Occupational and Professional Licensing (DOPL).

    Agreement & Informed Consent

    By signing below:

    - I give informed consent to receive massage therapy services from Tavish Burton, LMT.
    -I have disclosed all relevant medical information and will inform my therapist of any health changes before future sessions.
    -I understand and agree to the terms outlined in this document, any violation of these terms will result in an inablility to book future sessions and will revoke any prepaid sessions with no refunds given. 
    -This consent remains valid for future sessions unless revoked in writing.

     

  • Please note that we require at least 24 hours' notice for cancellations or rescheduling. Late cancellations or no-shows will result in a $25 cancellation/ no show fee.

    By signing below, I acknowledge that I understand and agree to the cancellation policy.

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