Forms | Forrest Massage & Spa

Massage Intake Form

Client Information

Name *

Email Address *

Phone Number *

Birthdate

Age *

Address *

City / State / Zip *

Emergency Contact Name *

Phone Number *

Relationship *

Occupation *

Referred by

How did you hear about us? (e.g. Google, Facebook, Yelp)

Health Information

Are you taking any medications? *YesNo

If yes, please list *

Any allergies? (oils, lotions, nuts, fruits, skin, etc) *YesNo

If yes, please list *

Are you pregnant? *YesNo

If yes, how many months *

Due Date *

Are you currently under medical supervision or receiving other medical intervention? *YesNo

If yes, please describe *

Health Information

Areas of broken skin? (e.g. rash, wounds) *YesNo

If yes, where? *

History of joint replacement surgery? *YesNo

If yes, which joint(s)? *

Recent injuries or medical procedures in the past 2 years? *YesNo

If yes, please describe: *

Please describe any other injuries or health conditions:

Massage Information

Have you had professional massage before? *YesNo

If yes, How recently? *

Reason for seeking massage? *RelaxationSpecific problem

Please describe: *

How much pressure do you prefer? *LightMediumFirm

Please indicate any areas of discomfort:

Massage Policy Notification

Thank you for choosing us as your massage and bodywork provider. In order to provide the best service possible to our clients, we have implemented the following policies:

Cancellation & No Show Policy

We require at least 24 hours notice to cancel an appointment. Clients who cancel an appointment with less than 24 hours notice will be billed 50% of the price of the scheduled service. Clients who do not show up for a scheduled appointment or notify us in advance will be billed for the full price of the scheduled service. We understand that emergencies and illnesses can arise; therefore, last-minute cancellations due to things such as verifiable emergencies, illnesses, or inclement weather will generally not result in any missed session charges. However, this is to be determined at the practitioner's discretion.

Late Arrival Policy

All scheduled appointments will end at the scheduled ending time in order for us to stay on schedule. Clients who arrive late to their scheduled appointment will be charged for the full session and will not receive a time extension. For your first appointment, please arrive 15 minutes prior to your scheduled appointment time to allow time to complete the Client Intake Form. For all other appointments, please arrive 5 minutes before your scheduled appointment time to allow time to undress and get on the table to enjoy a relaxed and unhurried experience.

Massage Termination

Only professional massage and bodywork services for relaxation or therapeutic purposes are offered at this massage practice. Massage services will be terminated immediately in the event of inappropriate conduct of any kind. This includes harassment, threatening speech or behavior, sexual advances or requests, or disrespectful actions or language. A session will not be conducted if the client is under the influence of drugs or alcohol. If the massage is terminated for any of these reasons, full payment for the scheduled session is still required.

Draping Policy

Clients will be appropriately draped with a sheet and/or towel at all times during their massage. Only areas of the body that are currently being treated will be exposed. The breast and genital areas will always remain draped and are never massaged.

Massage Guidelines and Expectations

1. Massage sessions will begin and end at the scheduled time. Sessions that begin late due to the client's late arrival will end at the scheduled time, and the client will be billed for the full session.

2. All clients will be treated with respect and dignity. Personal and professional boundaries will be respected at all times.

3. Clients must provide an accurate health history and agree to inform their therapist of any updates or changes to their health/medical condition.

4. Any client with a contagious condition, including common cold, influenza, stomach flu, coronavirus, meningitis, shingles, contagious skin conditions, etc., must not come into the office but call to inform the therapist before the scheduled appointment time. Clients may reschedule their appointment after the contagious condition has resolved.

5. Clients with signs or symptoms of an active systemic or localized infection (e.g., fever, sore throat, swelling, etc.) at the time of a scheduled massage are asked to notify their therapist and reschedule their appointment.

6. Massage therapists only provide therapeutic massage and modalities that are within the scope of practice for this licensed profession. Clients with acute injuries or conditions that are outside of the scope of practice for massage should consult with their doctor.

7. All clients will be appropriately draped with a sheet at all times during the massage session. Only the areas of the body that are currently being worked will be exposed. The genital area is never exposed or massaged.

8. Client privacy and confidentiality will be maintained at all times.

9. Any client who arrives under the influence of drugs or alcohol will be asked to leave.

10. This is a non-smoking, odor-neutral massage office.

11. Clients are expected to be clean and have showered prior to receiving massage (on the same day).

12. All clients are provided with a competent and professional massage that focuses on the needs of each individual client.

13. Harassment of any kind is not tolerated, and the session will be terminated if this occurs, or if the practitioner's safety is compromised in any way.

14. Clients are asked to avoid eating a heavy meal during the two hours prior to receiving massage.

15. Appointments are confirmed between one to ten days prior to the scheduled appointment.

By signing below, I acknowledge that I am aware of the benefits and risks of massage therapy and that I have completed this form to the best of my knowledge. I also agree to inform my massage therapist of any health or medical changes.

Client Signature *

Date *

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