forms

Client waiver form

  • I understand that fascial stretch/massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation, range of motion and energy flow.
  • If I experience pain or discomfort during the session, I will immediately inform my practitioner so that pressure can be adjusted to my level of comfort. I will not hold my practitioner responsible for any pain or discomfort experienced during or after the session.
  • I affirm that I have notified my practitioner of any changes in my health and medical condition. I understand that there shall be no liability on the instructor(s) part should I forget to do so.
  • I understand that stretch/massage therapy sessions are designed to assist in greater stretch gains and are non-sexual in nature.
  • I understand that there is a 24-hour cancellation policy. If I am unable to cancel before that time I will be responsible for the costs associated with that session.
  • I agree that this is a cash only business and insurance will not be accepted. Health Savings Accounts are accepted, however client is responsible for obtaining documentation.
  • I understand the services offered today are not a substitute for medical care. I understand that my practitioner is not qualified to perform spinal or skeletal adjustments,diagnose, prescribe, or treat physical or mental illness.
  • By signing this release (typing my name below), I hereby waive and release my practitioner from any and all liability,past, present and future relating to these fascial stretch/massage sessions/bodywork. I have read and agree to these policies therein.
  • Today's Date
    Date Format: MM slash DD slash YYYY

New Client Intake Form

  • Date Format: MM slash DD slash YYYY



  • General Information




  • Please enter a number from 1 to 10.



  • Physical Factors




  • Please enter a number from 1 to 5.



  • Medical History







  • The above information is accurate and true to the best of my knowledge. If there are any changes in my current level of health, I will inform the person that I am seeing of my condition. I understand that this office does not diagnose or treat illness or disease and does not prescribe medications. I agree to pay my account with this office in accordance with the regular rates and payment terms. If, for any reason, cancellation is necessary, I will give a 24-hour notice. I understand that if I do not give this notice, I will be charged for the appointment unless it can be filled. Owner will determine emergency cancellations. It is agreed that any claim of liability is hereby waived.




  • By signing this release (typing my name below), I hereby waive and release my practitioner from any and all liability,past, present and future relating to these fascial stretch/massage sessions/bodywork. I have read and agree to these policies therein.
  • Date Format: MM slash DD slash YYYY