Client Intake & Consent Form

1. Have you experienced a Professional massage in the past?
2. What kind of pressure do you prefer?
3. Where are your main areas of focus today?

4. Are you comfortable with having therapeutic massage on the following areas?

Gluteal Region
Upper Pectoral Muscles
Feet
Face/Head
5. Are you currently experiencing any of the following conditions?
6. Are you pregnant?

8. Please check ALL of the health conditions below that have affected your health either currently or in the past

MUSCULOSKELETAL
CIRCULATORY
NERVOUS SYSTEM
RESPIRATORY
SKIN
OTHER

Time

  • The client will present at the agreed-upon location on time.

  • If a client causes the appointment to start late, the client forfeits that time and may be treated for the remaining time of the session.

  • If the client is not at the location specified, then the Massage Therapist will attempt to make contact. If contact is not reached, it is considered a no-show and the appointment will be forfeited. 

  • The client can reschedule or cancel at any time up until 72 hours before the appointment.

Confidentiality

  • Renewed Being does not share information about the session with others.

  • Renewed Being will never sell your data. Your contact information is used only by us to update and inform you of things pertaining to your account as well as offers from the company. You may opt out of any marketing sent to you directly by us at any time.

Health

  • The client confirms that they have not been around anyone that they know that has or have had COVID19 in the past 14 days. Also that they have not had any symptoms for the past 4 days.

  • There are no open wounds that are exposed.

  • The client and Therapist will wear masks during the sessions.

Treatment

  • The client determines what clothing to be worn during the session.

  • The Therapist discusses what is most helpful for the specific treatment; however, the client makes the final decision.

  • The client determines which area not to treat (i.e., no foot strokes due to being ticklish).

  • The client will remain covered at all times and only the area being worked on will be uncovered.

  • The client needs to communicate wanted / unwanted pressure levels with the therapist.

  • The client must provide adequate space for the Therapist to set up the massage table and to be able to move around the table to provide massage therapy to the client. 

  • Any person under the age of 18 years old must be accompanied by an adult during the session.

  • If the client would like another person (i.e., spouse, friend) to observe the session, that may occur provided the person adheres to the established boundaries.

  • No sexual behavior / intonation is tolerated.

Payment

  • Full payment is required to reserve the appointment.

Agreement

We agree to adhere to the specified boundaries stated above. If for some reason the client cannot adhere to the boundaries, the Therapist will discuss a course of action that may result in the right to refuse treatment of the client.

 

I understand that the massage/bodywork I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during the session, I will immediately inform the Therapist so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage or bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand the massage/bodywork Therapists are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because massage/bodywork should not be performed under certain medical conditions, I affirm that I stated all my known medical conditions and answered all questions honestly. I agree to keep the Renewed Being and the Therapist updated as to any changes in my medical profile and I understand there shall be no liability on Renewed Being or the Therapist's part should I fail to do so. I also understand that any illicit or sexually suggestive behavior or remarks during the session will not be tolerated; resulting in the session ending immediately and the amount paid for the appointment will be forfeited. I understand that, because massage therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. By signing this form, I acknowledge that I am aware of the risks involved and give consent to receive massage and bodywork from this practitioner.