BY APPOINTMENT ONLY. CALL TO BOOK. 913.904.8814 - 2108 W. 75TH ST, SUITE C, PRAIRIE VILLAGE, KS 66208
POLICIES: These will be agreed to and signed by you prior to starting your first session.
INTAKE FORM
CANCELLATIONS/RESCHEDULING:
★ If I am not able to make a massage, I agree to cancel or reschedule the appointment at least 24 hours in advance of the time of the scheduled appointment. I agree to pay 50% of the full session rate if I give less than 24 hours notice.
★ I agree to pay the full session rate if I give 2 hours notice or less, or if I miss an appointment without giving notice.
★ If, within 24 hours of my session, I develop a contagious illness, or have a sudden, unplanned health or personal emergency rendering me unable to make my appointment, I will inform Scents of Touch right away. If they are unable to fill my vacancy, I will pay the cancellation fee, or session fee (if less than 2 hours notice), unless an exception is granted, only at the discretion of Scents of Touch.
★ Pregnant Clients: If I go into labor within 24 hours of an appointment I agree to notify Scents of Touch and they will waive the cancellation fee. If I go into labor and do not notify Scents of Touch, and I miss my appointment, I agree to pay the full session rate.
★ I understand that I am still responsible for my appointment until I hear back from a staff member confirming they received my email or phone call requesting cancellation/rescheduling.
ARRIVING ON TIME/SESSION LENGTH:
★ I understand I must arrive 10-15 minutes early for any appointment in order to get the full session time I have scheduled. If I arrive on time, or late, I understand the therapist can only give me whatever time remains of my appointment, and that I will pay for the full length of session that I booked.
★ I understand that in order for me to receive the best massage therapy possible, I know that I have to communicate ANYTHING and everything, including my needs, preferences, requests, or feedback at any time before, during, or after my massage. I take it upon myself to communicate right away if there is anything distracting me or if I feel unwell or uncomfortable at any time during the session so that she can make adjustments. I understand that my therapist wants my HONEST feedback positive or negative - and doesn’t take offense to it.
DISCLAIMER/RELEASE: I understand that therapeutic massage/bodywork is a health aid and does not take the place of a doctor's care. If I experience pain or discomfort during the session, I will immediately inform the practitioner so that the pressure and/or strokes, or any other factors, may be adjusted to my level of comfort. Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree that my practitioner and Scents of Touch LLC shall not be liable should any injury occur, due to my withholding information, or for any other reason. I agree to keep my practitioner updated as to any changes in my medical profile, and I understand that there shall be no liability on the practitioner’s part should I fail to do so. Information exchanged during any therapeutic session is educational in nature, and is intended to help me become more familiar and conscious of my own health. It is to be used at my own discretion and is not to be construed as medical advice. Proper and ethical draping (covering with a sheet and blanket) will always be used. Only the body part being worked on will be exposed. I acknowledge that this a professional environment and the practitioner has the right to terminate the session at any time for any inappropriate behavior including, but not limited to, physical or verbal, and payment will be due for the full session.
PRECAUTIONARY CORONAVIRUS LIABILITY RELEASE FORM
Due to the outbreak of the novel Coronavirus, COVID-19, we are taking extra precautions with the intake of each client, health history review, as well as sanitation and disinfecting practices. Please complete the following and sign below.
Symptoms of COVID-19 include:
•Fever •Fatigue •Dry cough •Difficulty breathing •Chills •Nausea or vomiting •Diarrhea
•Confusion •New widespread muscle pain •Headaches •Red or purple toes
•Loss of taste & smell •Bruising, redness, swelling, or cramping in lower legs and feet
I, __________________________________________, agree to the following (PLEASE INITIAL EACH BELOW):
_____ I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days.
_____ I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the last 30 days.
_____ I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the last 30 days.
_____ I affirm that I, as well as all household members, have not traveled outside of the country, or to any city outside of our own that is or has been considered a “hot spot” for COVID-19 infections within the last 30 days.
_____ I understand that this business, Scents of Touch, LLC and my massage therapist, Rachel Brimm, cannot be held liable for any exposure to the virus or any other contagion caused by misinformation on this form or the health history provided by each client.
_____ I understand that because massage therapy involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. I acknowledge that I am aware of the risks involved and give consent to receive massage and bodywork from this practitioner.
By signing below, I agree to each above statement and release this massage therapist and business from any and all liability for the unintentional exposure or harm due to COVID-19. This massage therapist and this business agrees that they abide by these same standards and affirm the same. We also affirm that we have improved and expanded our sanitization protocols to more thoroughly fight the spread of COVID-19 and other communicable conditions.