• Aligned Bodywork New Client Intake Form

    Please complete this form before your scheduled session.
  • Date of Birth*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • General Health Status

  • Are you Pregnant?*
  • Do you have any of the following skin conditions or concerns? (Check all that apply):*

  • Please check any current or past health conditions that apply:

  • Cardiovascular & Circulatory*
  • Musculoskeletal conditions*
  • Neurological*
  • Other medical conditions*

  • Illness Screening

    *Please inform your massage therapist of any changes prior to your appointment if you are experiencing cold or flu symptoms, or have been exposed to an illness, so that your session may be rescheduled.
  • Are you currently experiencing any symptoms of illness? (fever, cough, sore throat, congestion, etc.)*
  • In the last 10 days, have you tested positive or been in close contact with someone with a contagious illness?*

  • Massage Preferences & Session Details

  • Have you ever received a professional massage/bodywork before?*
  • Have you been advised or referred by a healthcare provider to receive massage therapy?*
  • Pressure preference*

  • Consent & Policies

    ~Please read & sign~

  • Informed Consent

    - I understand that massage therapy is not a substitue for medical care or treatment. I understand that my massage therapist does not diagnose medical conditions.

    - I understand that I am responsible for informing my massage therapist of any changes in my health, medications, or medical conditions. I understand that certain conditions may require modification or may be contraindicated for massage therapy, and it is my responsbility to disclose relevant health information.

    - I understand that I may request adjustments to pressure, technique, or positioning, or stop the session at any time.

    -I consent to receive massage therapy services.

     

     Cancellation & No-Show Policy

    24 hours notice is required for cancellations or rescheduling. Late cancellations (less than 24 hours notice) or no-shows may be charged 50% of the scheduled service fee. If you need to cancel within that 24 hour window, please reach out to your massage therapist directly. Exceptions may be made at the therapist's discretion.

     

    Late Arrival Policy

    Arriving late may shorten your session to respect the next client's appointment time. Full session fee still applies. If you are going to be late, please reach out to your massage therapist directly.

     

    Termination of Session

    As the massage therapist, I (Haley) reserve the right to end the session at any time if inappropriate, unsafe, or unprofessional behavior occurs. I also reserve the right to refuse or discontinue future services to any client at my descretion.

     

    Privacy & Confidentiality

    Your personal and health information will be kept confidential and used only for providing services, scheduling, and business purposes, unless required by law. 

     

     

  • Date*
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