Client services and chart information are confidential. Written authorization is required from you to release any information.
I understand the Restorative Therapies Bodywork is a massage service with the intent of providing high quality bodywork in a clinic setting or other agreed upon location that supports a therapeutic envioronment.
I will reschedule my session or prorate my remaining time if I am to be more than 15 minutes late.
I understand there is a 24 hour cancellation policy and I am subject to immediate full payment of the appointment. (unforseen sickness, accidents, and similar circumstances are typically forgiven)
I understand I will be protected by draping and at no time will genitals or breast tissue be exposed.
I understand my session will include a consultation with my therapist to ensure the most effective treatment.
I understand that my therapist or I may end the session at any time for any reason.
If my session runs over the allotted time I understand and agree to pay additional fees.
I understand that no refunds are given at any time, however, all session time purchased will be fulfilled unless otherwise stated herein.
If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort.
I further understand that massage/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 that massage/bodywork practitioners 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.
I understand that the skeletal system, brain or nervous system, endocrine system, respiratory system, immune system, elimination system, reproductive system, digestive system, circulatory system, or any cellular systems are not directly treated or altered.
Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly.
I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I fail to do so.
I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for full payment of the scheduled appointment.
I understand there are no guarantees or promised claims toward any particular result in terms of injury recovery or structural recovery due to the multitude of factors that make up such physical dysfunctions. I also understand that my practitioner will make every possible attempt to recover to the fullest potential any injury or structural dysfunction I've sustained.
I understand that I am not "getting rid of" any condition. I understand that Restorative Therapies Bodywork cannot confirm or deny any diagnosis nor offering treatment specifics. I understand Restorative Therapies Bodywork cannot make recommendations about treatments other than common sense guidelines. I understand these bodywork sessions do not replace medical treatments, therapy, or medications. I understand that bodywork sessions are not constructed as practicing medicine, healing, or curing conditions. I understand that Restorative Therapies Bodywork cannot promise specific results or claiming to perfom healings or cures.
However, if something miraculous occurs you are free to call it as such!
I understand that this document may be amended at a future time and I agree to any such amendments.
Understanding all of this, I give my full consent to receive care with Restorative Therapies Bodywork.
By my electronic signature below, I agree to the massage policy and client agreement above.