Client Intake Form

Signature and Waiver #1

*Please read and sign*

·       I affirm that I answered this form honestly as to my medical conditions and injuries.

·       If I experience any pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.

Signature and Waiver #2

*Please read and sign*

·       I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow.

·       If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.

·       I understand that today’s services are not a substitute for medical care and that my therapist is not qualified to diagnose, prescribe, or treat physical/mental illness.

·       I affirm that I have notified my therapist of all known medical conditions and injuries.

·       I agree to inform the therapist of any changes in my health and medical condition and that there shall be no liability on the therapist’s part should I forget to do so.

·       I understand that massage is entirely therapeutic and non-sexual in nature.

·       By signing this release, I waive and release my therapist from any liability, past, present, and future, relating to massage therapy and bodywork.

·       I understand that massage therapy involves physical touch and that, as with any bodywork or physical activity, there is a small risk of temporary soreness, bruising, or other minor side effects.

·       I voluntarily choose to receive massage therapy and assume full responsibility for any risks, known or unknown, that may arise from this treatment.

·       I hereby release, indemnify, and hold harmless the business, therapist, employees, and affiliates from any and all liability, claims, or damages, whether known or unknown, that may result from the massage therapy session.

·       I understand that accurate and complete health information is essential to providing safe massage services. I agree to disclose all known medical conditions and medications. I understand that withholding information may result in injury, and I release the therapist from liability for complications arising from undisclosed conditions or medications.

Signature and Waiver #3

*Please read and sign*

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Scheduling & Appointments

• Appointments are available by appointment only; walk-ins are not accepted.
• New clients must complete a health intake form before the first session.
• Please arrive 5–10 minutes early for check-in and preparation.
• Late arrivals may result in a shortened session to avoid delaying the next client; the full session fee still applies.
• No-shows will be charged the full session rate unless canceled within the required time frame.

Cancellation Policy

• Cancellations or reschedules must be made at least 24 hours in advance.
• Cancellations with less than 24 hours’ notice are subject to a 50% late cancellation fee.
• No-call / no-show appointments will be charged 100% of the session fee.
• Repeated cancellations or no-shows may result in refusal of future bookings.

Payments

• Payment is due at the time of service.
• Accepted forms of payment: cash, credit and debit cards that are accepted via “Square”

• If payment is made via card, the processing fee will be passed down to the client.

• Payment is due either before the session begins or immediately following the session.
• Gratuities are accepted but not expected. We want to give you an exceptional experience at G.M.T. without any extra expectations.

Professional Boundaries

• Massage therapy is strictly therapeutic and non-sexual. Any sexual remarks, advances, or misconduct will result in immediate termination of the session. The client will be charged the full fee, and the incident may be reported to appropriate authorities if necessary.
• Clients must be properly draped at all times; only the area being worked on will be uncovered.
• The therapist reserves the right to refuse or end a session if safety, health, or professional boundaries are compromised.

Communication and Feedback

• Feedback is always welcome. Please let your therapist know about any preferences, goals, or areas of concern so we can tailor your experience to your needs.

Health & Safety

• Please reschedule if you are ill, contagious, or have a fever.
• Please notify your therapist of any changes to your health status or medications prior to each session.
• The therapist reserves the right to decline service to clients who appear sick, intoxicated, or under the influence of drugs or alcohol.
• Any open wounds, skin infections, or contraindicated conditions must be disclosed before the session.
• Clean linens and sanitized equipment are used for every client in compliance with state and local health regulations.

Confidentiality

• All client information is kept strictly confidential and will not be shared without written consent, except as required by law.
• Health history forms are used solely to ensure safe and effective treatment.

Scope of Practice

• Massage therapy is intended to promote relaxation, relieve muscle tension, and improve circulation. Massage therapists do not diagnose medical conditions, prescribe medications, or perform spinal adjustments. Any health concerns should be discussed with a licensed medical professional.

Client Expectations

• Clients should maintain good personal hygiene before appointments.
• Please remove jewelry or items that may interfere with the session.
• Cell phones should be silenced or turned off during treatment.
• Communicate with your therapist during the session about comfort, pressure, or pain levels.
• If any discomfort or pain arises during your session, please let your therapist know immediately so adjustments can be made. This ensures your comfort and helps your therapist understand your preferences for future sessions.

Therapist Rights

• The therapist reserves the right to refuse or terminate a session at any time if:
       o The client’s health condition is contraindicated for massage.
       o The client demonstrates disrespectful or inappropriate behavior.
       o The client violates cancellation or payment policies.
• The therapist reserves the right to cancel or reschedule any session due to illness, emergency, or unsafe conditions, with as much notice as reasonably possible. In such cases, no charges will apply.

Service Precautions

• Deep tissue may result in minor bruising, and the therapist won’t be held responsible if client does not inform therapist of discomfort during massage.
• Some therapies (such as cupping or scraping) may leave temporary marks that fade within a few days. These are normal and not indicative of injury
• Prenatal massage is only available after the first trimester, with doctor’s clearance if needed.

Consent to Treat

• I understand that massage therapy is a therapeutic, non-sexual service. I have disclosed all relevant health information and consent to receive massage treatment provided by the therapist. I understand that I may stop or modify treatment at any time for any reason.

• I understand that massage therapy is not a substitute for medical examination, diagnosis, or treatment.

• Clients under the age of 18 must have a parent or legal guardian present during the session and must provide written consent before treatment begins.

     o For underage clients, the parent or legal guardian are liable for payment for child at time of service.

 

Acknowledgment of Policies

By signing below, I have read and understood the above policies and agree to abide by them during my treatment sessions. I understand the nature of massage therapy, the potential risks, and my responsibilities as a client. I have had the opportunity to ask questions and all have been answered to my satisfaction.