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Serenity Massage & Bodywork by Angela
General Liability Release Form/ Informed Consent Form
I understand that the massage given to me by Angela Jessie LMT is for the purpose of (stress reduction, pain reduction, relief from muscle tension, increasing circulation, or specific reasons stated in medical intake form). I understand that the massage therapist does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage therapy. I understand that massage therapy is not a substitute for medical care and that it is recommended that I work with my primary caregiver for any condition(s) I may have. I have stated all my known physical conditions and medications, and I will keep the massage therapist updated on any changes.
1) I give my permission to receive massage therapy and I'm not under the influence of any substance.
2) I have clearance from my physician to receive massage therapy. (If applicable)
3) I understand the risks associated with massage therapy include, but are not limited to:
- Superficial bruising
- Short-term muscle soreness
- Exacerbation of undiscovered injury
I therefore release Serenity Massage & Bodywork by Angela (Angela Jessie LMT) from all liability concerning these injuries that may occur during the massage session.
4) I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the massage session so he/she may adjust accordingly.
5) I understand that I or the massage therapist may terminate the session at any time.
I appreciate that you’ve chosen Serenity Massage & Bodywork by Angela for your massage and bodywork needs. To provide the best service possible to my clients I have implemented the following policies.
I respectfully ask that you provide a 24 hour notice of any schedule changes or cancellation requests. Please understand that when you cancel or miss your appointment without providing a 24 hour notice I am often unable to fill that appointment time. If more than 2 appointments have been cancelled without proper notice, prepayment for service is required to book further appointments. I understand that emergencies can arise and illnesses do occur at inopportune times. If you have a fever, a known infection or have experienced vomiting or diarrhea within 24 hours prior to your appointment time, I request that you cancel your session. Inclement weather may also result in the need for late cancellations. I will do my best to give advanced notice if I need to cancel due to bad weather and I ask you to do the same. Please do not risk your own safety trying to make your appointment. Late cancellation due to emergency, illness, or inclement weather will generally not result in any missed session charges, but this is determined on a case-by-case basis.
Late Arrival Policy:
I request that you arrive 5-10 minutes prior to your appointment time to allow time to fill out any required paperwork as well as answer any intake questions your therapist may have. I understand that issues can arise that may cause you to be late for your appointment. However, I ask that you call to inform me if this ever occurs so I can do my best to accommodate you. Appointment times are reserved for each client, so oftentimes I cannot exceed that reserved time without making the next client late. For this reason, arriving after your appointment time may result in loss of time from your massage so that your session ends at the scheduled time. Full service fees will be charged even when sessions are shortened due to late arrival. In return I will do my best to be on time, and if I am unable to do so we will add time to your session to make up for our late arrival or adjust the service charge accordingly. Please note that all appointment times are approximate.
Inappropriate Behavior Policy:
Massage therapy is for relaxation and therapeutic purposes only. There is absolutely no sexual component to massage whatsoever. Any insinuation, joke, gesture, conversation, or request otherwise will result in immediate termination of your session and a refusal of any and all services in the future. You will be charged the full service fee regardless of the length of your session. Depending on the behavior exhibited I may also file a report with the local authorities if necessary. Treat your therapist with respect and dignity and you will be treated the same in return.
Serenity Massage& Bodywork by Angela accepts all major credit cards, cash and money orders for services and products. No Personal Checks are accepted.