66343 158820 client policy statement by 8289566Y


									                Luminescent Massage, LLC
                            by Brianna Honey
                Client Policy Statement/Informed Consent Agreement

Brianna Honey, L.M.T, is a graduate of Baltimore School of Massage and is nationally
certified by the National Certification Board for Therapeutic Massage and Bodywork.
She is licensed in the state Maryland to practice Massage Therapy and Bodywork, and is
a member of the American Massage Therapy Association.

      Scope of Practice- there will be no diagnosis, practice of medicine, practice of
       chiropractology, or bone adjustments (however bone positioning may change as
       a result of soft tissue manipulations made by certain modalities), or claim to
       treat any specific illnesses or disease: please consult a physician prior to
       engaging in any new exercise or health regimen. Please read the specific
       descriptions of each modality before scheduling a session to understand what to
       expect and what they entail. With the highest regard to respect and modesty to
       clients, some modalities such as Structural Integration involves ‘charting’ which
       involves the therapist viewing the client while in front of a line chart for
       assessment purposes.
      Benefits of Massage include, but are not limited to:
           o Increased circulation
           o Stimulates the flow of lymph, the body’s natural defense system
           o Relaxes and softens injured and overused muscles
           o Reduces spasms and cramping
           o Increases joint flexibility
           o Reduces recovery time, helps prepare for strenuous workouts and
                eliminates subsequent pains of the athlete at any level
           o Releases endorphins - the body's natural painkiller - and is being used in
                chronic illness, injury and recovery from surgery to control and relieve
           o Improves range-of-motion and decreases discomfort for patients with
                low back pain.
           o Provides exercise and stretching for atrophied muscles and reduces
                shortening of the muscles for those with restricted range of motion
      Contraindications to Massage:
           o Please inform the therapist if you currently have: bruised areas, open
                wounds, break in skin, or recent burns. Colds, flu, contagious, or
                infectious conditions should also be reported to the therapist.
           o Persons with uncontrolled high blood pressure, heart disease, recent
                surgery or fractures, phlebitis, fever should consult their physicians
                before receiving a massage, and will need a written consent from the
                physician before the massage can take place. Inform the Therapist of any
                restrictions that may apply.
           o ***Current medical information of the client is important to discuss
                before the session.***
      Sessions:
           o 1 hour Swedish massage - $70.00
           o 1 ½ hour Swedish massage - $110.00
           o 1 hour Deep Tissue - $80.00
           o 1 ½ hour Deep Tissue - $120.00

              Luminescent Massage, LLC
                          by Brianna Honey
                    Payment is due after the session is finished.
                    Cash and checks will only be accepted. Returned check fee is
                     $35.00. If check is returned, the outstanding payment must be
                     made in cash. (Only Clients at Quest Fitness may use credit cards)
                  Insurance is not accepted.
   Appointments scheduled upon availability.
   Client Confidentially is held in the highest regards and will not be transmitted
    by any means without written authorization by the client or client guardian or
    without an official court order. Anyone under the age of 18 must have signed
    authorization from a parent or legal guardian in order to receive
   Etiquette:
        o Please show up 10 minutes early to the session to allow time to fill out
            the health intake form and/or update the therapist on any new health
        o Use of drugs or alcohol prior to session is not recommended.
        o It is preferred that the client shower/bath before session.
        o Please allow 24 hours advance notice of a cancellation.
   Sexual Impropriety- sexual innuendos, language and behavior will not be
    tolerated. The session will end immediately and the client will be charged the
    full price if such an occurrence takes place.

               Luminescent Massage, LLC
                         by Brianna Honey

Client Signature: ________________________________________ Date: ____________

Therapist Signature: _____________________________________ Date: ____________


To top