Health Intake Form

Client Intake Form – Therapeutic Massage

Please fill out all fields completely. Thank you. If you would like to schedule, please use the schedule online button or the contact us form. We do not read the health intakes until just before your visit. If you would like to print out the health intake instead of submitting it, click here.

Personal Information:

The following information will be used to help plan safe and effective massage sessions. Please answer the questions to the best of your knowledge.
Draping will be used during the session – only the area being worked on will be uncovered. A parent or legal guardian must accompany clients under the age of 17 during the entire session. Informed written consent must be provided by parent or legal guardian for any client under the age of 17.
I understand that the massage I receive is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during this session, I will immediately inform the therapist so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or other qualified medical specialist for any mental or physical ailment that I am aware of. I understand that massage therapists 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 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 to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapist’s part should I fail to do so.
Cancellation Policy: Please arrive between five and ten minutes before your scheduled appointment time in order to ensure a full massage session. If you arrive more than ten minutes before your scheduled appointment time, please know you may have to watch us eat our yummy lunch to refuel our hardworking bodies. We have a strict no-lunch-sharing policy, so do not try to trade us for our Jello pudding cup. • You may cancel your appointment without charge 12 hours prior to your scheduled appointment. Messages are fine;we would rather have you cancel over voicemail than not at all and leave us wondering if you were in a car accident. • Sorry, we cannot go over your appointment time. If you are late, you are out of luck. No deductions of session fee if you are late. Thank you for valuing our time! • If you do not call to cancel your appointment or do not show up for your scheduled appointment, you will be charged full price for the scheduled service. If your credit card you reserved for payment does not successfully authorize for payment, you will be sent a paper invoice. If the paper invoice is not paid within 30 days of receipt, the invoice will be sent to collections. Thank you for ensuring that our business and personal bills are not affected by your inability to be responsible for your own time. • If it is your first visit and you no show or late cancel, any "first time" discounts on your subsequent visit will be null and void.

 

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Please call the office to schedule 30 minutes.

Hours of Operation

Office Hours
Monday 10am-6pm
Tuesday 10am-6pm
Wednesday 10am-6pm
Thursday 10am-6pm
Friday 10am- 6pm
Saturday 9am-1pm

Michele's schedule
Mon. 2-8pm
Tues. 2-8pm
Wed. 9-3pm
Thur. 9-2pm
Fri.-8:30-2:30pm

Kyron's schedule
Mon.- 2:30-6pm
Tues.- 3:45-7pm
Wed.- 12-6pm
Thurs.- off
Fri.- 12-6pm
Sat.- 8-1pm

Amanda's schedule
Mon.- 3-9pm
Tues.- 9-12pm
Wed.- 2-7pm
Thurs.- 2-7pm
Sat.- 9-3pm

Kimberly's schedule
Tues.- 1-6pm
Fri.- 1-6pm

Lori's schedule
Tues.- 9-1pm
Thur.- 1-5pm

Contact Us

614-604-MELT(6358)
1501 Stonecreek Dr. S. Suite 101 Pickerington, OH 43147
info@bodyacheescape.com

Location


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