Name
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First Name
Last Name
Phone
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Email
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Birth Date
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Reason for massage treatment:
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Other Treatments
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Do you receive massage treatments regularly? If so, how often?
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Oils, lotions, and other skin products are used during treatment. List any skin sensitivities or allergies to specific ingredients or essential oils:
Past or new injuries?
Cardiovascular
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Head & Neck
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Infectious Conditions
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Neurological
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Reproductive
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Respiratory
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Skin
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Miscellaneous
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Emergency Contact
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First Name
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Emergency Contact Phone
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Doctor's Name
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First Name
Last Name
Doctor's Phone
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How did you hear about us?
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Social Media
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Referred by someone
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If you are a referred client, please list name of referral:
Additional notes you would like your provider to know?
By signing this release, I hereby waive and release my therapist from any and all liability, past, present, and future relating to massage therapy and bodywork.
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Late Arrival Policy
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Sacred Healers Haven LLC respectfully asks that all clients arrive at least 5-10 minutes prior to appointment time to reduce interruptions to client service. We understand that there may be situations leading to late arrivals. We appreciate receiving an alert or message at client’s earliest convenience if a late arrival is imminent.
While we do not place intake evaluation and dressing times as part of client service to provide a “full-time hands-on” experience, we do not extend appointments for late arrivals to reduce interruptions onto our next appointment.
We will contact clients by text message at 5 minutes late and call by 10 minutes late. If for any reason client does not respond by 15 minutes late, we reserve the right to no-show appointment, charge full payment without refund, and/or flag client from booking any future services (if booked by client or business without prepayment).
Please read Cancellation Policy for rescheduling fees.
Cancellation Policy (Effective Sept. 9, 2024)
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Cancellations within 48 hours of the scheduled appointment time will be charged 50% rescheduling fee, this will be used toward your next appointment as a credit.
Cancellations within 24 hours will be charged 100% rescheduling fee, this will be used toward your next appointment as a credit.
No-shows will be charged 100% of the service fee, which cannot be used toward future appointments. If last-minute cancellations become a repeated issue, the service fee will be charged and cannot be used as a credit and/or client may be banned from booking future services.
Wellness Members can cancel or reschedule within 24 to 48 hours of scheduled appointment time without forfeiting membership credit. However, if late-cancellations become a repeated issue, Member may be subject to forfeit membership credit within rescheduling window, or place membership on pause, and lastly, termination.
Cancellations/no-shows without a card on file may be banned from booking future services.
Missed appointments without a card on file: First missed appointment may be waived and allowed to be rescheduled without additional fees. After rescheduled visit, card will be required to save on file to avoid future missed appointment. Second missed appointment without card on file, client will be banned from booking future services
We will waive rescheduling fees in the event of accidents, injuries, or illnesses. Please contact us within 48 hours for cancellations and rescheduling.
Health and Safety Policy
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Sacred Healers Haven LLC requires that all clients reschedule appointments in the event of illnesses or minor/major injuries that may require medical attention. If you are experiencing symptoms related to colds, flu, fever, COVID, or other contagious symptoms, we ask for at least 48 hours (if possible) to reschedule your appointment. We will waive cancellation fees for illnesses, accidents, or injuries.
If we suspect that a client presents contagious symptoms or illness, and/or require medical attention at the time of their appointment, we respectfully ask to reschedule, and will not allow service to proceed. We recommend waiting at least 10 days after recovery from an illness to resume services.
Client Conduct Policy
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Sacred Healers Haven LLC is a professional establishment, therefore, we reserve the right to refuse, terminate, flag, or cancel appointments, memberships, and future services for reasons associated with client conduct. Inappropriate behavior will not be tolerated, whether client is using, expressing (verbal, nonverbal, and physical), or offering sexual comments, gestures, jokes, requesting personal favors, or violating Therapist’s boundaries.
Any client exhibiting inappropriate behavior, whether current, regular, or prospective, will or may be charged full payment without refund, reported to local authorities, and banned from booking future services. We respectfully ask that our professional, ethical, and personal boundaries are treated with dignity, as we serve our community with the highest regard for health and safety.
