Client services and chart information are confidential. Written authorization is required from you to release any information.
• Please turn off your cell phone for optimal relaxation
• Your scheduled session is set aside for you. We do not double book appointments
• Please reschedule your session if you are more than 15 minutes late
• 24 hour cancellation notice is required to avoid being charged for your session
• You will be draped and at no time will genitalia or breast tissue be exposed
• You will have a consultation with your therapist to discuss your session
• Should the session require, after your therapist has left the room, you may disrobe to your comfort level
• I understand that my therapeutic massage therapist or I may end the session at any time for any reason
• Inappropriate behavior will not be tolerated and may be prosecuted to the full extent of the law
I understand that therapeutic massage therapists do not diagnose illness, disease, any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform joint mobilization.
I acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that a physician be seen for that service.
It is my choice to receive therapeutic massage as a form of therapy.
I understand that treatment given is designed to address the care and prevention of myofascial pain and dysfunction.
I also undersand that at any time I feel pain or discomfort during the session, I will immediately inform my therapeutic massage therapist so they adjust.
I have stated my pertinent medical conditions, and will update the massage therapist of any changes in my health status.
I understand that my failure to do so may post a threat to my health and/physical well being and I hold harmless GalactiCenter Bodyworks and my therapeutic massage therapist from any liability whatsoever arising from failure on my part.
I understand that the novel Coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). I understand that COVID-19 is extremely contagious and may be contracted from various sources. I understand COVID-19 has a long incubation period during which carriers of the virus may not show symptoms and still be contagious. I understand that I am the decision maker for my health care. Part of this office’s role is to provide me with information to assist me in making informed choices. I understand the benefits and risks associated with the provision of health care during a pandemic.
I confirm I am not experiencing any of the following symptoms of COVID-19 listed: Fever, shortness of breath, dry cough, sore throat, runny nose, loss of taste or smell
I understand that both the therapist and myself are required to wear a mask during the session with the exception to when I am in prone position (faced down).
PARENT/GUARDIAN WAVIER FOR MINORS:
If the client is less than 18 years old, the Client’s parent and natural guardian hereby represents that he/she is,
in fact, acting in that capacity, has consented to his/her child or ward’s availing of the services of GalactiCenter Bodyworks, LLC, and has agreed individually and on behalf of the child or ward, to the terms of this “Informed Consent and Wavier”. The undersigned parent or guardian further agrees to save and hold harmless and indemnify GalactiCenter Bodyworks, LLC from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon GalactiCenter Bodyworks, LLC relating to massage therapy and body work on behalf of the Client and all of the Client’s parents or legal guardians.
By my electronic signature below, I agree to the massage policy and client agreement above.