150 S Pacific Coast Hwy # F, El Segundo CA 90245
8329 Lincoln Blvd, Los Angeles CA 90045
This record of consent is required before the first assessment or treatment and will be maintained confidentially in the client file. It may only be released to a third party with prior written consent of the client.
Massage Therapy includes the assessment and treatment of the soft tissues and joints of the body, using soft tissue manipulation, joint mobilization.
By signing below, the client agrees to the following:
All massage treatments, information and records will be kept confidential and securely stored for use only by my massage therapist.
Written consent must be given by me prior to any disclosure or sharing of my personal and clinical information with any third party, unless subpoena is handed.
Privacy will be assured as I have the right to undress only to my comfort level and according to the requirements of the treatment.
Draping will be used by the therapist as required to expose only those parts of my body that require treatment and/or as I choose to ensure my comfort during treatment.
If at any time during the treatment, I feel uncomfortable with the treatment for any reason, I have the right to request an immediate stop to the session or request modifications to the treatment, regardless of prior consent given. If massage is stopped on the first 15 minutes no charge will apply, if even I dislike the service but received it in full fees will be due as expected.
Promptness is expected for all appointments. In the event of lateness, the massage may be cut short due to the therapist other commitments. Fees will be maintained per the schedule.
Cancellation of any appointment must be received at least 24 hours in advance. No show or last minute cancelation will be liable to full fee payment.
Fees for treatment are due prior to departure on the day of the treatment. Cash or credit cards are accepted.
The therapist may refuse to treat any client or part of their body with just and reasonable cause.
The above information is accurate and true to the best of my knowledge. I understand that massage therapist do not diagnose disease, prescribe medication or manipulate bones. I further understand that massage therapy is not a substitute for medical attention or examination. Because massage therapy 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 take responsibility for alerting my practitioner to any physical, mental or emotional changes that occur with my health and understand that shall be no liability on the practitioner's part should I forgot to do so.
It is also understood that any illicit or sexual suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for payment of scheduled appointment.
I, also, understand that cancelled or missed appointments without 24hours notice (medical emergencies excluded)may be charged in full to my credit card on file for the price of missed session.