• New Client Massage Intake Form

    All information is held confidential. At no given point is information disclosed or shared without client’s written consent. 
    New Client Massage Intake Form
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  • Health Information

  • Health History

  • Acknowledgement and Waiver

  • Client information is confidential and written authorization is required to release any information.

    We do not double book appointments.

    You will be draped and at no time be exposed.

    You may end the session at any time for any reason.

    Inappropriate behavior will not be tolerated and may be prosecuted to the fullest extent of the law.


    Client Agreement:

    • I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow.
    • If I experience pain or discomfort during the session, I will  immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.
    • I understand that today's services are not a substitute for medical care and that my therapist is not qualified to diagnose, prescribe, or treat physical/mental illness.
    • I affirm that I have notified my therapist of all known medical conditions and injuries.
    • I agree to inform the therapist of any changes in my health and medical condition and that there shall be no liability on the therapist's part should I forget to do so.
    • I understand that massage is entirely therapeutic and non-sexual in nature.
    • By signing this release, I waive and release my therapist from any liability, past, present, and future, relating to massage therapy and bodywork.
  • Consent to Treat a Minor:

    By my signature below, I hereby authorize Tiffany Miller, LMT or Mercy's Touch Massage to administer massage, bodywork, or other therapeutic teachniques to my child or dependent as they deem necessary. 

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