Massage Policies

Client services and chart information are confidential. Written authorization from you is required to release any information.

• Please turn off your cell phone for optimal relaxation.
• Your scheduled session time is reserved exclusively for you. We do not double-book appointments.
• Please reschedule your session if you are more than 15 minutes late.
• A minimum of 24 hours’ notice is required for cancellations to avoid being charged for your session.
• You will be draped at all times; genitalia and breast tissue will never be exposed.
• You will have a consultation with your therapist to discuss your session prior to beginning.
• If the session requires it, you may disrobe to your comfort level after the therapist has left the room.
• I understand that either my massage therapist or I may end the session at any time for any reason.
• Inappropriate behavior will not be tolerated and may be prosecuted to the fullest extent of the law.

Client Agreement

I understand that therapeutic massage therapists do not diagnose illness, disease, or any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform joint mobilization.

I acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that I consult a physician for such services.

It is my choice to receive therapeutic massage as a form of treatment.

I understand that any treatment provided is designed to address the care and prevention of myofascial pain and dysfunction.

I also understand that if at any time I feel pain or discomfort during the session, I will immediately inform my massage therapist so that adjustments can be made.

I have stated all pertinent medical conditions and agree to update my massage therapist regarding any changes in my health status.

I understand that failure to do so may pose a risk to my health and/or physical well-being, and I agree to hold harmless Salud Mobile Massage and my therapeutic massage therapist from any liability arising from such failure on my part.

By my electronic signature below, I agree to the Massage Policies and Client Agreement above.

Consent to Collect and Exchange Personal Information

Purpose
Your personal information may be collected, used, and disclosed by the insurer and/or plan administrator of your group benefits plan, their affiliates, and service providers for purposes including: assessing eligibility, processing and administering claims, underwriting, auditing, investigating fraud or plan abuse, and internal data management or analytics.

Authorization & Consent
I authorize my healthcare provider to collect, use, and disclose personal information related to any claims submitted on my behalf to the insurer and/or plan administrator and their service providers for the purposes stated above.

I also authorize the insurer and/or plan administrator and their service providers to:
• Use my personal information for the purposes listed above.
• Exchange my personal information with individuals or organizations—such as healthcare professionals, investigative agencies, insurers, reinsurers, government benefit administrators, other benefit programs, or related service providers—when relevant to these purposes.
• Exchange personal information related to my claims with any assignee of benefits payable.
• Exchange personal information electronically or by any other secure method.

Benefit Assignment 

I assign the benefits payable for my eligible claims to the healthcare provider who submits my claims electronically, and I authorize the insurer/plan administrator to pay that provider directly. If my claim is declined, I understand that I am responsible for all charges for services and/or supplies received.

I acknowledge that the insurer/plan administrator is not obligated to accept this assignment. Any benefit payment made to the provider under this assignment fully discharges the insurer/plan administrator from its obligations for that payment. If benefits are paid to me instead, the insurer/plan administrator is likewise discharged of its obligation for that payment.

I understand this assignment applies to all eligible claims submitted electronically by my healthcare provider and that I may revoke it at any time by providing written notice to the insurer/plan administrator.

If I am a spouse or dependent, I confirm that I am authorized by the plan member to make this assignment.