Remedial Therapy Intake Form Logo
  •  *** MOBILE + TABLET USERS ***

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    All information provided will be kept confidential unless required by law.
    At no given point is information disclosed or shared without a client's written consent.
    Bold titles below with a red asterisk * are required to have information typed into the relevant box. If you have attempted to submit your form and you get "There are errors on the form......", you need to scroll up to the highlighted field to complete before clicking on the submit form button again.

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  • Massage Policies:

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

    • Please turn off your mobile phone for optimal relaxation

    • Your scheduled session is set aside for you. We do not double book appointments

    • Please reschedule your session if you are more than 15 minutes late

    • 24+ hour cancellation notice is required to avoid being charged for your session

    • You will be draped and at no time will genitalia or breast tissue be exposed

    • You will have a consultation with your therapist to discuss your session

    • Should the session require, after your therapist has left the room, you may disrobe to your comfort level

    • I understand that my Massage Therapist or I may end the session at any time for any reason

    • Inappropriate behaviour will not be tolerated and may be prosecuted to the full extent of the law

  • I have provided all my known medical information. I acknowledge that massage therapy is not a substitute for medical diagnosis and treatment. I consent to receive treatment.

    By my electronic signature below, I agree to the treatment policy and client agreement above.

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