• Client Intake Form

    Client Intake Form

    All information is confidential and at no given point disclosed or shared without the clients written consent. Please read each question carefully. You are encouraged to give as much information as possible for treatment purposes.
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Health History

    Please check all that apply.
  • Client Liability & Consent

  • I understand that massage and bodywork may provide benefits for certain conditions which may include relief of muscular tension, relaxation, improvement of circulation, reduction in symptoms of stress related conditions and provision of general wellbeing, but results are not guaranteed.

    I understand that side effects of massage and bodywork may include muscle soreness, mild bruising, increased areas of pain, aggravation of certain medical conditions, tissue swelling and light-headedness amongst other possible temporary outcomes.

    I will advise the therapist of any discomfort I may experience during the session and understand that the therapy will be adjusted accordingly. I will not hold the therapist liable for any pain or discomfort during or after my session.

    I understand that draping will be used throughout the session to ensure my privacy and that only the area being worked on will be undraped. I understand that all sessions are entirely professional and therapeutic.

    I am aware that the Licensed Massage Therapist is not qualified to diagnose, perscribe medications or perform spinal or skeletal adjustments, nor will the therapist attempt to perform techniques for which they have not been trained or certified. I understand that massage therapy is not a substitution nor replacement for proper medical or chiropractic care.

    I have been informed of session costs prior to services being rendered and agree to pay all balances in full on or before the date of service.

  • By signing below, I agree to all of the above and the following:

     

    The information I have provided regarding my medical history is accurate to the best of my knowledge. I understand the information given pertaining to the requested therapy and confirm that I do not have any condition(s) that would make treatment unsuitable. I agree to recieve therapy today and in all future scheduled appointments in the form of massage and bodywork and confirm that I am of 18 years of age. I agree to waive all liablity toward Teal Therapeutic Bodywork LLC.

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  • Policies & Procedures

  • CANCELATION POLICY

    Cancelations made after 24 hours will be charged 50% of the session price. Same day cancelations and or no shows will be charged the full amount of the session price; prepaid appointments will not be refunded. Booking will not be allowed until all cancelation fees are paid in full. If you arrive late to your appointment, you will receive only the allotted amount of time left based on the length of the session booked. Full payment is required if your session needs to be cut short due to the fault of the client. You will receive a confirmation text 24 hours prior to the day and time of your appointment as a reminder. If you are experiencing any symptoms of fever or illness, please contact as soon as possible to cancel and reschedule your session. Proper notice will be given pertaining to days and or hours appointments will not be available or need to be rescheduled by the therapist.

     

    BOOKING POLICY

    Sessions are by appointment only. To request an appointment, please text, email or fill out the contact form on our website and leave your full name, phone number and email. Repeat clients may book all appointments online. New clients will receive a text, call or email to briefly discuss your upcoming session and confirm your appointment and appointments will only take place once the client has responded to either form of communication. Please schedule at least 24 hours in advance to obtain your preferred date and time. When booking, you may choose to create an account on our website to hold all of your appointment information and history.

    Note: All appointments must be booked by the person receiving the session. You may not make an account or appointment for another client and appointments cannot be booked using another client's account or information.

     

    REQUIRED FORMS POLICY

     All clients new or repeat must have a completed intake and consent form on file prior to the first appointment. can take place. These forms must be updated with current health information and signed on the date of completion. The purpose of these forms is to provide important information that allow the massage therapist to make decisions and adjustments to treatment for the safety of the client. Please be sure to let the therapist know of any recent health changes or surgeries that may interfere with the session.

     

    PAYMENT POLICY

     Payment for all sessions is due by or on the day of service with no exceptions; pricing will be discussed prior to client agreement to treatment. Accepted methods of payment include cash or card and can be made online upon booking or in person. No refunds will be made once services have been provided.

  • I have read and agree to abide by all Policies and Procedures listed above so long as I am a client of Teal Therapeutic Bodywork LLC.

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