PLEASE NOTE:

The weight limit for my table is 300lbs

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you hear about BounceBack?

Any Areas of Focus For Massage

Any Areas to Avoid

Any Current Medical Conditions

Are you pregnant?

Emergency Contact Name

Emergency Contact Phone

(###)

###

####

Policies

Scheduling and Communication: You may call, text or email to schedule an appointment at any time of day you like. If the line goes straight to voicemail when you call, please note that Do Not Disturb is enabled when in client sessions or taking personal time. I will respond as soon as possible during business hours (Mon-Fri 8 AM to 5 PM, Sat/Sun 9 AM to 3 PM). If you are hoping for a same day appointment, texting is best because I will see your message between appointments. Texting Policy: Text communication is solely for the purpose of appointment scheduling and massage related questions. Cancellations: I would appreciate as much advance notice as possible if you are going to miss a session. If you need to cancel or reschedule an appointment, please do so at least 12 hours in advance. Because I have set aside the time for you, all appointments canceled less than 12 hours in advance will be billed at the usual rate. If you are more than 10 minutes late and have not texted or called to let me know, I will assume that you are not coming to that session. I understand that emergencies happen, so I allow one grace late cancellation/no-show per client before charging for the session. ENTER FULL NAME BELOW TO AGREE

Consent to Treatment

I understand that the bodywork I receive is provided for the purpose of relief of muscular tension and dysfunction, relaxation, and stress reduction. If I experience pain or discomfort during this session, I will immediately inform the practitioner so that the posture, pressure, temperature, or any other factors can be adjusted to my comfort level. I further understand that massage therapy is not a substitute for medical treatment or medications, and that it is recommended that I concurrently work with my Primary Caregiver for any condition I may have. I am aware that the massage therapist does not diagnose illness or disease, does not prescribe medications, and that spinal manipulations are not part of massage therapy. I have informed the massage therapist of all my known physical conditions, medical conditions and medications, and I will keep the massage therapist updated on any changes. ENTER FULL NAME BELOW TO AGREE

Today's Date

YYYY

Location

Scheduling

Contact