I understand that it is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage for this appointment and all future appointments. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis.
I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status.
I understand that my personal health information will be collected. I understand that all information that I provide will be kept confidential unless required by law. I understand and consent that my medical information may be shared by the various care providers involved in my care and treatment.
Treatments may be covered by extended health care plans. I understand that it is my responsibility to confirm the exact details of my coverage.
I understand that my email address will be used to send me appointment reminders or to inform me of changes to my appointments. My telephone number may also be used for contact purposes by the practitioner.
I understand that I am required to provide a minimum of 24 hours notice to the practitioner in the event that I need to cancel my appointment. If I give less than 24 hours notice, I agree that I will pay for the full cost of the booked session. I understand the importance of arriving on time for my session and agree to contact my practitioner if I am running late. I acknowledge that arriving late to my appointment will result in a shorter appointment time and that my treatment will end at the originally scheduled time. I understand that if I arrive more than 15 minutes late to my appointment, without notifying my practitioner, it will be considered a 'no show' and I will be required to pay for the full cost of my appointment.
I have read and agreed the terms and conditions above. I agree to using an electronic signature below
