Personal Intake Information

Check the following conditions that apply to you, past and present: 

Informed Consent

I understand that MLD is intended to enhance relaxation, reduce pain, and improve circulation.

The general benefits of MLD are:

• Reduces pain and eleviates spasms
• Calming the "fight or flight" side of the nervous system
• Supporting the immune system
• Decongesting tissue including scar tissue adhesions, shoulder, hip, and knee replacements
• Prepares tissue for surgery by removing excess water, toxins, bacteria and metabolic wastes
• Stimulates fluid circulation and promotes urination 
• Recovery from surgery (including plastic), headaches, fatigue, fibromyalgia,  swelling (edema), chronic inflammations and lymphedema, whether due to surgery, post mastectomy or other health issues

MLD contraindications are as follows: 

• Cancer
• Acute inflammation with infection (flu, cold, bladder, lung etc.)
• Congestive heart failure (CHF)
• Deep Vein Thrombosis (blood clots)
• Cellulitis
   

The general benefits of MLD and the contraindication have been listed above. I understand that MLD is not a substitute for medical treatment or medications, and that it is recommended that I concurrently work with my Primary Caregiver for any condition I may have. I am aware that the massage therapist does not diagnose illness or disease and does not prescibe medications.  

Late Arrival Policy:

We request that you arrive 5 minutes prior to your appointment time to review your intake form and answer any questions you or the therapist may have.   We understand that issues can arise that may cause you to be late for your appointment.  However, we ask that you call to inform us if this ever occurs so we can do our best to accommodate you.

Appointment times are reserved for each client, so oftentimes we cannot exceed that reserved time without making the next client late. For this reason, arriving after your apointment time may result in loss of time from your treatment so that your session ends at the scheduled time. 

Full service fees will be charged even when sessions are shortened due to late arrival.  In return we will do our best to be on time, and if we are unable to do so we will add time to your session to make up for our late arrival or adjust the service charge accordingly. 

Cancellation Policy: 

Your business is valued and your cooperation is appreciated. We are making a commitment to you to guarantee your appointment time and refusing all other requests once you have made the appointment.

• A 24-hour cancellation notice is required for any scheduled appointments including gift certificate sessions
• Missed or no-show appointments will result in your being charged the full amount of the session booked.
• Depending on our booking schedule, late appointments may not receive the full session time allotted for the treatment booked. Full payment is required.