Intake Appointment And Agreement Request Form

Intake Appointment And Agreement Request Form

Share your details and review the required session agreements to submit your request.
Client Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Email Address
example@example.com
PHOTOGRAPHY CONSENT AGREEMENTFOR BACK MASSAGE & ASSISTED STRETCHING SESSIONSYour face will not be photographed, recorded, or shown at any time. All images will be carefully framed to ensure that your face and identity remain 100% private and unrecognizable.
Agreement: Full payment is required before the massage session begins for all first-time male clients and clients who have not previously received a service at the standard rate.
MALE CLIENT CONDUCT & NON-REFUND POLICYAll massage services are strictly professional and therapeutic. Any disrespectful, inappropriate, harassing, or unsafe behavior toward the therapist will result in the immediate termination of the session. If a session is terminated for any of these reasons, all payments will remain non-refundable.
Signature
More Medical History To Let Us Know
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