• Mojo Massage

    Client Consent and Intake
  • Consent, Ceremony Agreement & Liability Release
  • Date of Birth:
     - -
  • Format: (000) 000-0000.
  • 1. Nature of the Work

  • Mojo Massage is a sanctuary for embodied transformation, offering intentional, intuitive, trauma-informed bodywork as support for body, heart, and spirit. Sessions may include massage, deep tissue, myofascial release, hot stones, somatic awareness, breathwork, intention setting, and other ritual elements. Sessions are held as co-created ceremonies oriented toward nervous system regulation, emotional processing, and spiritual remembrance, and are not a substitute for medical care, psychotherapy, or emergency support.
  • 2. Scope of Practice & Client Responsibility

  • I understand the practitioner is a massage and bodywork therapist, not a physician or mental health provider, and does not diagnose, prescribe, or treat medical or psychiatric conditions. I agree to share accurate health information-medical history, injuries, medications, trauma/touch sensitivities, and current physical or emotional concerns -and to update the practitioner if anything changes.
  • 3. Consent, Co-Creation, and Boundaries

  • Each session is co-created. I am invited-but not required-to share physical goals, emotional themes, and spiritual intentions that feel relevant. I understand that my consent is ongoing. I may at any time:
    • Ask questions about techniques or ritual elements.
    • Request changes to pressure, areas of focus, or pacing.
    • Decline or end any part of the session, including touch, for any reason.
    All touch is strictly therapeutic and non-sexual. Any sexualized comments or behavior will end the session immediately, and full fees may still apply. Professional draping is used at all times, and I may request adjustments.
  • 4. Possible Sensations and Risks

  • I understand sessions may include deep tissue, myofascial work, stretching, hot stones, and somatic/emotional processing. Possible temporary effects include soreness, tenderness, bruising, fatigue, emotional release (such as crying or shaking), or increased sensitivity. If I experience pain, overwhelm, or discomfort, I agree to communicate so the session can be adjusted or paused.
  • 5. Psychedelic / Spiritual Integration (If Applicable)

  • For integration-focused sessions, I affirm I will not be under the influence of illegal or unprescribed substances during the session. Any psychedelic experiences shared are for integration only. The practitioner supports somatic and spiritual integration and does not guide, administer, recommend, or supply any substances.
  • 6. Community, Payment, and Scheduling

  • Mojo Massage honors sacred reciprocity and community-rooted care.
    Unless another agreement is made, I agree to pay the stated rate at the time of service. I understand that:
    • Cancellations/reschedules require 24 hours' notice.
    • Late cancellations/no-shows may be charged up to the full fee.
    • Late arrival may shorten my session while full fees still apply.
  • 7. Confidentiality

  • My intake information and session notes are held in confidence except as required by law (for example, safety concerns or court orders). Records may be kept in physical or secure digital form.
    I consent to the collection and storage of my information for the purpose of providing services and complying with any legal or professional requirements.
  • 8. No Guarantees & Release of Liability

  • I understand that every body and process is unique and that no specific outcomes are guaranteed regarding pain relief, emotional release, or spiritual insight.
    By signing below, I voluntarily choose to receive massage, bodywork, and ceremony-based services at Mojo Massage and accept the inherent risks. To the fullest extent permitted by law, I release and hold harmless Mojo Massage and its practitioner from claims arising out of ordinary negligence in connection with these services, except where the law does not allow such a release.
  • 9. Consent and Signature

  • By signing, I confirm that I have read, understood, and had the chance to ask questions about this agreement. I am at least 18 years old, or my legal guardian is signing for me. I consent to receive services from Mojo Massage under the terms above.
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