Health History Intake Form

To enable a customized and safe treatment, all clients must fill out a health history form prior to treatment.  It is in the client's interest to provide a complete and honest health history, and to keep the therapist updated to any changes.

 

Confidentiality

All client records and sessions will be kept confidential and will not be shared without the written consent of the client, unless directed by court order.

 

Rescheduling/Cancellation Policy

A 24-hour advance notice is required when rescheduling or cancelling an appointment.  If you fail to provide 24-hour advance notice, you may be charged a $40 Late Cancellation Fee, which must be paid before your next appointment.

 

No-shows

Anyone who forgets their appointment, or misses a scheduled appointment for any reason without appropriate notification, may be charged a $40 No-Show Fee, which must be paid before your next appointment.  

 

Late Arrivals

Sessions are only guaranteed for the time of the original appointment.  Depending on what our schedule allows, we may be able to complete a partial or full appointment.  This will be at the discretion of the therapist, and the client will be responsible for the full session fee.  Please plan to be on time to receive the full benefits of the session.

 

Client Etiquette

Please shower prior to treatment, and refrain from the use of drugs or alcohol (If you are on pain medication, please let me know). I strictly provide non-sexual, therapeutic massage. If boundaries are perceived to be crossed, I reserve the right to end the session and/or terminate our therapeutic relationship.

​

Payment

Payment is expected at the time of service. I accept cash, checks, and credit cards.

Tipping is not expected.