Massage Therapy Intake Form (Page 2 of 2) in pdf

Patient Bill of Rights

 The therapists customize each massage to meet your specific needs.

 The patient has the right to considerate and respectful care

 The patient has the right to terminate the session at any time

 Personal and professional boundaries, privacy and confidentiality are respected at all times.

 We do not diagnose pathologies or conditions.

 All patients are respected, regardless of their age, gender, national origin, race, sexual orientation,

faith, socio-economic status, body type, political affiliation, state of health or personal habits.

 Clients are draped with a sheet at all times during a massage. Only the parts of the body being worked

on are exposed. Sexual body areas are never exposed or massaged

 The patient has the right to obtain complete and current information concerning their treatment in

terms the patient can reasonably be expected to understand

 The patient has the right to receive information to make an informed choice prior to the administering

of any treatment

 The patient has the right to refuse any treatment

 The patient has the right to expect a clean and hygienic therapist and table at all times.

Massage Therapist Bill of Rights

 A massage therapist has the right to be treated like a person and professional.

 Appointments start at the time they are scheduled. Promptness and courtesy are appreciated.

 Cancelled or missed appointments without 24 hour notice (medical emergencies excluded) will be

charged half the price of the missed session and shall be solely the patient’s responsibility

 A therapeutic massage by a licensed therapist is not erotic bodywork.

 The massage therapist can terminate the session for any reason.

 If you are satisfied with your session, tips or gratuities are not refused, but referrals are much more

appreciated.

 Draping a client during a massage is for both the client and the therapist.

By signing below, I have read, understand and agree to abide by the rights listed above, and I affirm that I

have truthfully answered all questions pertaining to my medical condition(s).

Signature: _______________________________________

Date______________________

Massage Therapy Intake Form Page 2