• Client Session Intake & Health History

    Please answer the following questions accurately.
  • Format: (000) 000-0000.
  • Inquired Date Session
     - -
    2 digit month, 2 digit day, 4 digit year

  • PLEASE ALLOW 24-48 HOURS FOR A REPLY. 

    While you wait, please fill out your health history & intake, consent and terms & conditions forms for a faster appointment confirmation below.

  • Health History

  • Are you currently under medical care or receiving treatment for any health condition?*
  • Have you had any recent injuries, surgeries, or accidents?*
  • Do you have any allergies, skin sensitivities, or reactions to massage products?*
  • Are you currently taking medication that may affect massage or your response to pressure?*
  • Are you experiencing pain, numbness, swelling, inflammation, or other symptoms you would like me to know about?*
  • Is there anything else that may affect your comfort or safety during a massage?*

  • Session Preferences

  • Preferred Pressure

  • Informed Consent

  • Informed Consent for Massage

    I understand that massage therapy is a professional service intended to support relaxation, comfort, and general well-being. Responses to massage vary by individual.

    Consent & Communication

    I understand that I may ask questions, request changes to pressure or positioning, decline any technique, or stop the session at any time.

    I understand that massage may sometimes result in temporary soreness or tenderness. I agree to communicate discomfort or concerns during the session.

    Draping & Professional Boundaries

    Appropriate draping will be maintained throughout the session. Only the area being worked on will be uncovered.

    Massage WILL NOT include genital areas, the gluteal cleft, or direct breast or abdominal massage. Gluteal massage, when appropriate and consented to, will be performed over the sheet.

    Sexual services are not offered. Sexual requests or inappropriate conduct will result in termination of the session.

    Client Acknowledgment

    I have had the opportunity to ask questions and understand the nature and boundaries of the service. I voluntarily consent to receive massage therapy.

  • Regulate & Release Bodywork Terms & Conditions

  • By booking a service with Regulate & Release Bodywork, you agree to the following terms.

    1. Booking & Payment

    Appointments must be booked in advance. Household and corporate bookings require a 50% deposit to secure the reservation. The remaining balance is due on the day of service.

    2. Cancellations & Refunds

    Cancellations made more than 24 hours before the scheduled appointment will receive a 100% refund of the deposit. Cancellations made within 24 hours of the appointment and no shows will result in forfeiture of the deposit. Rescheduling requests are subject to availability.

    Example: If your appointment is scheduled for Friday at 3:00 PM, you must cancel before Thursday at 3:00 PM to receive a full refund of your deposit.

    3. Travel Fees

    Additional travel fees may apply based on your location. Any applicable fees will be communicated before your booking is confirmed.

    4. Household Bookings

    Household bookings include consecutive individual massage sessions at one residence. All participants must complete the required intake and consent forms before receiving services.

    5. Corporate & Wellness Events

    Corporate bookings must be confirmed in advance, including event location, duration, estimated participant count, and schedule. Additional event requirements will be communicated before confirmation.

    6. Health, Consent & Professional Boundaries

    Clients must provide accurate health information and communicate relevant concerns before their session. Consent is required and may be withdrawn at any time. Services are professional massage therapy only. Inappropriate or sexual requests or conduct will result in termination of the session.

    7. Service Environment

    For outcall and household appointments, clients must provide a safe, clean, and suitable space for massage. Delays caused by access or preparation issues may reduce the available session time.

    Acknowledgment

    By booking, you acknowledge that you have read and agree to these terms. Additional intake forms, consent forms, or event agreements may be required depending on the service.

  • Your therapist will be replying to your needs shortly.

    Please allow for a 24 to 28 hour window for a response. 

    Thank you for choosing Regulate & Release Bodywork!

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