I will immediately inform the practitioner if there is something I am uncomfortable with or if I would like them to stop treatment on my infant at any point during the session. I further understand that massage/bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that my infant should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand that massage/bodywork practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all known medical conditions and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my child’s medical profile and understand that there shall be no liability on the practitioner’s part should I fail to do so. Understanding all of this, I give consent for my child to receive care.
I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this form.
Thank you!
Please review the following before your appointment.
For Payment
For payment, I accept cash, check and Zelle . I do not currently accept credit card payments. Payment is due at the end of each session.
Policies
Late Arrivals:
If you will be arriving late, please let me know by text. I will need to keep close to our scheduled ending time which means the duration of your session may be shortened in order to accommodate others whose appointments follow yours. The full session fee will still be owed.
Cancellation Policy/No Show:
In a desire to be effective and fair to all clients, 24-hour advance notice via text or phone is required when canceling or rescheduling an appointment. Clients that provide less than 24 hours notice or who do not show up for their session will be fully charged.
It is understandable that emergency or unexpected situations may occur in which reasonable accommodations and considerations will be made.
Thank you for your understanding. I look forward to having you!
