Massage Intake & Liability Release

Liability Release

Consent for Therapy and Waiver of Liability

The undersigned ("Client") hereby freely consents to receipt of service(s) from: Evergreen Massage

Client agrees as follows: Client understands and agrees that they will provide the Therapist with complete and accurate health information, and a written referral from the Client's primary healthcare provider if the Client is currently receiving care or has a specific medical condition or symptoms for which Client takes medication or received periodic evaluations or treatment. Client understands that massage therapy is designed to be an ancillary health aid and is not suitable for primary medical treatment for any condition.

1. Client and Therapist have discussed the potential benefits and possible side effects of massage therapy and have agreed upon a course of focused attention and manual therapy for the predetermined goals of stress reduction, relief of muscular discomfort, and/or promotion of general health. Client has been given an opportunity to ask questions of the Therapist and has received all requested information.

2. Client understands that the unclothed body will be and must remain appropriately draped AT ALL TIMES for warmth, sense of security, and as a mark of massage therapy professionalism. Client agrees to immediately inform the Therapist of any discomfort (both physically and emotionally) so that the application of pressure, technique, or draping may be adjusted to Client's level of comfort. Client understands that massage therapy is NOT sexual in any manner and that any illicit or suggestive remarks or behavior on the client's part, will result in an immediate termination of the therapy session, and may include involvement of law enforcement as deemed necessary by Evergreen Massage. Client understands that payment will be expected in full; regardless if the massage is completed or not.

3. Clients under the age of 18 must have a parent or legal guardian present for check in and the duration of the session (in the room if under 15 and must stay in the lobby if privacy is requested by client ages 15-18, and must provide a signature for authorization prior to the therapeutic massage session of a minor.

4. Client hereby assumes full responsibility for receipt of the massage therapy, and releases and discharges Therapist from any and all claims, liabilities, damages, actions, or causes of action arising from the therapy received here under, including, without limitation, any damages arising from acts of active or passive negligence on the part of the Therapist, to the fullest extent allowed by law.

5. Client, in signing this consent for Massage Therapy and Waiver of Liability ("Consent"), understands and agrees that this Consent will apply to and govern the current and all future massage therapy sessions performed by Therapist.

Cancellation & Refund Policy

Session deposits are nonrefundable. Sessions that are rescheduled more than 24 hours prior to the original appointment time will not be subject to a new deposit. An appointment may be rescheduled two times before a new deposit is required. If you fail to cancel or modify your session less than 24 hours before your scheduled appointment, a new deposit will be required before a new appointment can be made.

Refunds may be considered at the complete discretion of Evergreen Massage. No full or partial refunds will be given for late arrival of Client. If late arrival of Therapist is inevitable, every effort will be made to maintain the original length of your session. Client may choose to reschedule their appointment at no charge or accept a shortened session. If session is shortened to the remaining time left in the scheduled appointment time, Therapist will provide a discount of 5% for every 10 minutes the session is shortened.