AriFit Wellness Education STRETCH INTAKE

AriFit

Deep-Tissue Stretch Therapy™
BODYWORK INTAKE FORM

All sessions adhere to a 12 HOUR cancellation policy.
Name*

First NameLast Name
Email*
example@example.com
House-Call Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Deep-Tissue Stretch Therapy™ To ensure that Ari is able to accommodate your preferred appointment times, we ask that you schedule with as much advance notice as possible. Full Payment IS DUE UPON scheduling.
All aspects of your bodywork session are customizable to your preferences, including pressure, lighting, music, and whether you wish to converse or enjoy the treatment in silence. Do you have a preference?
Are you allergic to any scents, such as lavender or peppermint essential oils? Are you currently taking any prescriptions, such as blood thinners?
For example, blood thinners will cause client to bruise!
What brings you in for your session? Please describe any limitations, surgeries, or injuries you have experienced.
Have you ever received professional bodywork before? If so, what aspects of the session were most beneficial? If you discontinued, what led to that decision?
COVID-19 MASK PREFERENCE: *
Please note: For house-call sessions exceeding 20 miles of San Diego (92117), a $25 travel surcharge will need to be applied.*
Please type "I consent"
PLEASE NOTE: Standard appointments may be booked between 8:30 AM & 8:30 PM.*
Please type "I consent"
PLEASE NOTE: Stretch sessions that start before 8:30am, or after 8:30pm will include a $45 VIP Overtime Fee*
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PLEASE NOTE: If you'd like to extend your session appointment, additional time can be added at $75 per 30 minutes.*
Please type "I consent"
To ensure the smooth scheduling of your appointment, payment is kindly requested prior to your session. Please note that failure to complete payment in advance may result in the cancellation of your appointment. These policies are in place to protect the interests of both the service provider and valued clientele. We appreciate your understanding and cooperation.*
Please type "I consent"
I have read and understand that all appointments must be canceled at least 12 hours prior to the scheduled time. I acknowledge that I am responsible for 100% of the session fee if I cancel with less than 12 hours' notice.*

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Stretch Therapy & Bodywork Liability Waiver
By signing this release, you (the “Client”) knowingly and voluntarily waive and release your bodyworker, Arielle Kantor, and all affiliated persons, businesses, and entities from any and all liability—past, present, or future—arising from or related to stretch therapy, mobility training, or bodywork services. I understand that these services may involve physical movement, pressure, and assisted stretching, and that participation carries inherent risks, including but not limited to muscle soreness, imbalance, or unexpected physical responses.

I agree to communicate openly and immediately with Ari during and after the session if I experience discomfort, imbalance, pain, dizziness, or any adverse effects. I understand that this information is essential for my safety and for Ari to provide appropriate modifications and follow-up care.

I acknowledge that I have read this waiver in full, that I understand its contents, and that I freely and voluntarily agree to its terms. By signing below, I consent to receiving stretch therapy and bodywork services under these conditions.
Signature*

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I hereby declare that I have read the information above and have answered all precautionary intake questions honestly. REMINDER: AriFit services are NOT massage. Deep-Tissue Stretch Therapy combines fascia tissue techniques performed on a massage table while the client is wearing stretchy, yoga-like clothing. If you consent, please type your name.*

First NameLast Name
PLEASE ALLOW ARI 10 MINUTE LEEWAY FOR TRANSIT ARRIVAL TIME*

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AriFit

BODYWORK INTAKE FORM

Deep-Tissue Stretch Therapy™ To ensure that Ari is able to accommodate your preferred appointment times, we ask that you schedule with as much advance notice as possible. Full Payment IS DUE UPON scheduling.

Stretch Therapy & Bodywork Liability Waiver