• Massage Intake Form

    Massage Intake Form

    Soothing Oak Massage & Wellness
  • Date
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    2 digit month, 2 digit day, 4 digit year

  • General Information

  • Birth Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  •  -
  •  -
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  • Medical History

  • Have you been in an accident?*
  • If yes, when did the accident occur?
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you currently taking any medications?*
  • Are you currently pregnant?*
  • Do you suffer from chronic pain?*
  • Have you had any orthopedic injuries?*
  • Please check any of the following that apply to you, past AND present:

  • Massage Information

  • Have you ever received a professional massage before?*
  • Date of last massage
     / /
    2 digit month, 2 digit day, 4 digit year
  • Please check all that apply to the massage that you're seeking today:*

  • What makes a good massage for you?*

  • Check the complimentary elements to complete your service today:*

  • *Please note: Your therapist will go over everything with you during the consultation prior to your massage. If you have any questions or ever need to speak up during a massage, please do. We are intuitive in our work however, we do need you to speak up if you’re ever uncomfortable. If you need us to adjust the temperature, pressure, music, fan or anything else, please don’t hesitate to ask. This is all about you and your comfort.

  • Informed Consent

  • I agree that the above information is complete and accurate to the best of my knowledge and that I have included all medical conditions and prescriptions. I give consent to receive professional massage therapy and bodywork today. I understand that my LMT is not a doctor and will not be diagnosing or prescribing anything to you today or ever. I agree to notify my LMT of any changes to my medical information in the future. I understand that while massage and bodywork are extremely beneficial and insightful, it does not substitute a proper medical examination by your primary physician. Furthermore, I am aware that massage therapy’s effectiveness varies by individual and is not a guaranteed medical procedure or cure. Both the massage therapist & I will remain professional throughout all treatments at Soothing Oak. I understand that both the LMT & myself have the right to end the service at any time. Late cancellations & No-Shows may still be charged due to not being able to fill the time. I understand that if I am late to my appointments, it may run into my massage time if there is a client booked right after.

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  • Client Policy Statement

  • I have provided a complete and detailed medical history to my therapist and agree to inform Soothing Oak of any changes to my medical records in the future. I have also read and understand the following statements and policies:

    1. Cancellation Policy: To cancel or reschedule appointments, it is required to provide Soothing Oak with no less than 5hrs notice. If the appointment time goes unfilled, there will be a cancellation fee of $15 to cover the time the therapist had set aside and prepared for you. No-shows and appointments canceled with less than 5hrs notice can & will be charged 100% of the service and any prepaid massage or package can & will be applied towards the missed appointment.

    2. Treatment: The benefits from massage vary according to individuals and their medical conditions. It is not guaranteed to provide a cure or have long-term results. Massage is best received when part of a regular wellness routine including hydration, healthy diet and exercise. The client is welcome to question anything regarding the treatment that they are receiving at any time.

    3. Draping: All clients will always be safely and comfortably draped throughout all services at Soothing Oak Massage & Wellness Studio. The top blanket is for your added comfort but is not required, however, the top sheet is required by Florida law. No areas that are not being worked by the therapist will be exposed at any time. The one exception to this rule is if you are receiving a sports massage, in which case the therapist may request that you wear appropriate athletic wear as we may integrate active & passive stretching into your service.

    4. Safety: We will always maintain your safety here at Soothing Oak, as well as looking out for our own safety. We will always remain respectful and appropriate and we expect the same treatment from our clients. Should the service ever need to be stopped at any time for any reason, it can be ended by the therapist and/or the client. Integrity & safety is our number one priority.

    5. Prepaid Services: All prepaid services will never expire; however, they are nonrefundable. Packages and prepaid services may be transferred to another person with the appropriate communication between client & Soothing Oak. All Massage & Yoga packages are on a monthly basis and will be renewed a month after your first date of purchase, only with your consent. Prepaid massage packages may be shared with up to two family members and have no expiration or monthly renewal requirements.

    6. Soothing Oak is not responsible for any lost, damaged or stolen personal belongings. Please silence your phones and anything you don't need should be locked in your vehicle upon arrival.

    7. Coupons & Special Offers: May not be combined with other offers or used more than the time allowed unless the coupon or offer states otherwise.

    8. Credit Cards & Personal Information: Will never be shared or stored anywhere unsafe. We can save your card in your file, however, we DO NOT have access to viewing any sensitive information. We will not give ANY of your information to anyone else.

    9. Late Arrivals: We set our day up to accommodate every client accordingly. Many of our appointments are back-to-back. Please be sure to arrive only 5 minutes prior to your appointment. If you are late, you risk the chance of cutting into your scheduled massage time.

     

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