Client
Intake Form

1. I understand that massage therapists, body workers, and holistic practitioners are not medical doctors and do not diagnose illness, disease, or any physical or mental disorder. I acknowledge that massage and alternative holistic therapies are not substitutes for medical treatment, and that Flow Massage Therapy LLC, ("Flow"), recommends I see a primary healthcare provider for medical services. I understand that it is my responsibility to communicate with my therapist if I have concerns or questions about my session. I do not have any injuries or conditions that would prevent me from receiving a massage, nor have I been told by a health care provider that I should not receive massages or alternative therapies. 2. I understand that massage therapy and bodywork services are a therapeutic health aid and are non-sexual. I understand my massage therapist reserves the right to end a therapy session in the case of sexual innuendo or advances from the client. I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the massage, and I will be liable for full payment of the scheduled session. 3. Any information exchanged during a massage or bodywork session is confidential and is only used to provide me with the best health care services available. I understand that a massage therapist will ask me questions about my health and physical condition and that I am obligated to answer truthfully and honestly about my health history in full detail. 4. I understand that my feedback is essential in my treatment, and that if I experience any unusual discomfort and/or pain during my massage session, it is my responsibility to inform the therapist in order to enable the therapist to adjust the pressure or technique being used. 5. The therapist reserves the right to decline, discontinue, or restrict services based on any provided information that may indicate that massage therapy would put my health or the therapist's health at risk. 6. I acknowledge that I am responsible for being  on time for my appointments and that the therapist is not under any obligation to extend my therapy session. I also agree that I am responsible for paying  for the full-time I have booked with the therapist if I am late. I understand that my appointment time is reserved for me only. If I miss an appointment or am unable to give twenty-four (24) hours' notice when I need to change or cancel my appointment, I agree to pay Flow in full for the booked appointment time. I further understand that I will be charged an additional thirty dollars ($30.00) for any returned checks. 7. I understand that massage therapy and bodywork are for the purposes of stress reduction, relief from muscular tension and spasms, general relaxation and improvement of circulation and energy flow. 8. I understand that the massage therapist practitioner does not prescribe medical treatment of pharmaceuticals, nor does he/she perform any spinal manipulations. 9. I understand that services offered today, and in the future, are not a substitute for medical care and that any information provided to me by the therapist is purely for educational purposes and is not diagnostically prescriptive in nature. 10. I have stated all of my known medical conditions on the Client Intake form. I have consulted a medical doctor or licensed medical health care practitioner regarding any checked or described conditions. 11. I understand that it is solely my responsibility to keep the therapist updated on any changes in my physical health and I further understand that Flow and the therapist shall not be liable for any reason whatsoever, should I fail to keep the therapist updated on any changes in my physical health. 12. I have reviewed this form in its entirety and I have discussed all my concerns regarding my treatment with my therapist.

CLIENT: By signing this “Informed Consent and Waiver”, I consent to receive therapy by Flow Massage Therapy LLC, and hereby agree to all policies of Flow Massage Therapy LLC, and waive and release Flow Massage Therapy LLC and its entire staff, massage therapists, and bodywork practitioners from any and all past, present, and future liability, loss, cost, claim, or damage whatsoever which may be imposed upon Flow Massage Therapy LLC relating to massage therapy and bodywork; including, but not limited to, reflexology, acupressure, polarity therapy, energy therapy, Reiki, nutritional therapies, all forms of kinesiology, aromatherapy, craniosacral therapy, myofascial release therapy, trigger point therapy, stretching therapy, strength and condition training, among others. I further undertake to indemnify and hold Flow Massage Therapy LLC harmless from any accident(s) arising from my use of Flow Massage Therapy LLC’s services. I agree to and acknowledge the foregoing.

 If the client is less than 18 years old, the Client’s parent and natural guardian hereby represents that he/she is, in fact, acting in that capacity, has consented to his/her child or ward’s availing of the services of Flow Massage Therapy LLC, and has agreed individually and on behalf of the child or ward, to the terms of this “Informed Consent and Waiver”. The undersigned parent or guardian further agrees to save and hold harmless and indemnify Flow Massage Therapy LLC from all liability, loss, cost, claim or damage whatsoever which may be imposed upon Flow Massage Therapy LLC relating to massage therapy and bodywork; including, but not limited to, reflexology, acupressure, polarity therapy, energy therapy, Reiki, nutritional therapies, all forms of kinesiology, aromatherapy, craniosacral therapy, myofascial release therapy, trigger point therapy, stretching therapy, strength and condition training, among others, on behalf of the Client and all of the Client’s parents or legal guardians. I agree to and acknowledge the foregoing.

I understand that each appointment I have is very important either for my own treatment process or that of another who could potentially fill the time slot. I agree to notify Flow Massage Therapy LLC within 24 hours. If I am unable to do so, I understand that I will be responsible for the payment for the scheduled time, unless it can be filled by another. I have read and understand this cancellation policy.