Client Policy Statement by WV05FP


									                                      Client Policy Statement
Massage involves the manipulation of tissue through touch and energy to promote a client’s well-being and
health. I am certified to practice massage in the state of Colorado, and am a member of the Association of
Bodywork and Massage Professionals. I currently provide services in:

          Swedish                                                     Shiatsu
          Deep Tissue                                                 Structural
          Cranial Sacral Therapy                                      Sports

I am available for massage sessions in studio Monday – Wednesday, 10AM to 3PM, and Friday 10AM –
5PM, by appointment. If the need to cancel your appointment should arise, please do so with 24 hours
notice. If cancelled within 24 hours, you will be charged a $25 cancellation fee. If I am able to fill your
slot within the 24 hours, no cancellation fee will be assessed. Payment will be collected prior to the start of
the session. I accept Visa, MasterCard, Cash, Check or Money Orders. A $25 fee will be charged for any
returned check.

Please arrive 15 minutes early for your first appointment to review your Health History form and intake
information. It is extremely important that I have thorough knowledge of your health history, as some
conditions are contraindicated for massage. While massage does promote better health, it should not be
construed as a substitute for a medical examination, diagnosis or treatment and that you should see a
qualified medical specialist for any ailment that you are aware of. I can not diagnose, prescribe or treat any
physical or mental illness, and the recommendations I make during the session should not be construed as

Your comfort level is a main focus. Once in the studio, you may undress to your comfort level, removing
as little or as much clothing as you wish. Please note that any clothing left on is considered a boundary and
I will not be able to work that area as effectively. I do work with my clients fully draped under a sheet and
a blanket, only exposing the area of the body that is being worked.

All client information, both verbal and written is kept completely confidential.

Clients are expected to arrive on time. If you arrive late, your session will still end at the appointed time,
and you will be charged for the full session. No show clients will be charged for the full session. Please
arrive to your session bathed. If intoxication of any kind is suspected, you will be asked to leave and still
be charged for the full session. I do recommend that you eat prior to your session, try to do so at least an
hour before.

It is the client’s responsibility to keep the therapist informed of any discomfort or pain during the session.
Only you know what is going on inside your body.

Massage is intended to be completely therapeutic. Sexual innuendoes, language and behavior will not be
tolerated. The session will end immediately and you will be charged for the full session if such an
occurrence takes place.

I, _________________________________, the client, have read and understand the current policies
provided in this document. I understand that these policies may change at anytime without notice. My
therapist will keep me informed of any changes.

______________________________________________                    ___________________
Client Signature                                                     Date

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