O So Relaxed

WELCOME! I would like to make your appointment as pleasant and comfortable as possible. If at any time you have questions
regarding your session, please let me know. Your answers to the following questions will be kept confidential. They will be
seen only by myself and are requested so that I may provide you with better care.
Name__________________________________________________________________________ Date___________________________
Address________________________________________________________________________Phone (day)______________________
City_____________________________________________ State______________ Zip________ Phone (eve)______________________
Age___ D.O.B.____/____/____ Sex___ Pregnant? ____ E-Mail Address____________________________________________________
Occupation_________________________ What do you do for exercise? ____________________________________________________
Pressure:____________________

Have you received previous massage work?_____________________________________________

Reason(s) for coming for massage now:

______________________________________________________________________________________________________________
Any specific areas you would like worked on?
______________________________________________________________________________________________________________

Any major traumas you have had to your body (e.g. accident, fall, etc.). Please include ALL muscle, bone or joint
injuries even if not recent: __________________
________________________________________
________________________________________
________________________________________
You may use the chart to the right to indicate areas of
discomfort or desired areas to work on.

Allergies? _______________________________
Drugs (prescription/recreational)?
________________________________________
Is there anything else I should know?
________________________________________

The following sometimes occur during massage. They are normal responses to relaxation and/or touch, and need not be embarrassed nor suppress them.
Movement or release of intestinal gas - crying - laughing - strong emotions - sighing - groaning - yawning - softening of muscle tissue - cognitive or felt
memories - stomach gurgling - need to move or change position. At any time during your session please let me know if there is anything I can do to help
you feel more comfortable.
I understand that the services provided are not a replacement for medical or psychological care and that any information provided is not prescriptive or
diagnostic in nature and is for educational purposes only. I also give my permission for the LMT(s) with whom I work to discuss information pertinent to
my condition(s) and treatment, with my other health care providers.

Client's Signature_____________________________________________________________ Date ____________

O So Relaxed Policy/Procedures/Consent/Release
I understand that massage therapy provided by O So Relaxed Massage Therapist is intended to enhance relaxation,
reduce pain caused by muscle tension, increase range of motion, improve circulation and offer a positive experience
of touch. Any other intended purposes for massage therapy are specified below:
The general benefits of massage, possible massage contraindications and the treatment procedure have been
explained to me. I understand that massage therapy is not a substitute for medical treatment or medications, and that
it is recommended that I concurrently work with my Primary Caregiver for any condition I may have. I am aware
that the massage therapist does not diagnose illness or disease, does not prescribe medications, and that spinal
manipulations are not part of massage therapy. Any inappropriate conduct/behavior will not be tolerated. I
understand that any sessions may be ended immediately. Please reference Refund policy below. I have informed the
massage therapist of all my known physical conditions, medical conditions and medications, and I will keep the
massage therapist updated on any changes. I have received a copy of the therapists policies, I understand them and
agree to abide by them.
I authorize the O So Relaxed Massage Therapist to release all relevant information from my therapeutic massage
sessions to my physician or other healthcare provider(s) as requested. Further I give consent to allow O So Relaxed
to consult with and/or receive similar information from my other healthcare provider(s) in order to facilitate my
treatment(s). I agree to be responsible for any balance(s) for services rendered to me by the LMT.
O So Relaxed has a Cancellation Policy in place and would appreciate if you would acknowledge it. We understand
that life happens but we require that you contact us if you are not able to keep your appointment. All late arrivals
appointment time may be shorten at managements discretion unless prior communication has been made. No Call/
No-show will forfeit appointment rescheduling until all payments have been rendered for missed appointment slot. If
you need to cancel an appointment we require at least 24 hours notice. 50% of the cost of the massage scheduled
will be charged for cancellations within 24 hours and payment must be render prior to rescheduling.
If you have a Massage Gift Certificate with O So Relaxed, please plan ahead in making an appointment. Waiting
until the last few days before your expiration date might make it more difficult in getting in before it expires, so
please call as soon as receiving Gift Certificate. Last minute cancellations and no-shows will result in full service
charges or void gift certificates. Fees are non-refundable and have no cash value on future appointments. Late arrival
and No Call/No Show policy also applies to Gift Certificates.
New Client Information can be obtained on the Home Page of othella.org in the bottom left corner. If you are unable
to retrieve the Intake Forms via the website, please arrive 15 minutes before for your appointment to allow for new
client information to be filled out if you are a new client.
If you are late you will receive only the amount remaining of your scheduled appointment including the time needed
to fill out paperwork. You will be considered a "No Show" if you are not there at your appointment within 15
minutes after the schedule appointment time and if there was no phone call with a message to cancel or reschedule.
If you are not familiar to where our location is we suggest you leave extra early so you will arrive promptly for
your appointment. No show-no massage-no refund. Refund request will be honored within 7-10 business days from
the date of the original refund request via email at obodywork@gmail.com all request will be rendered at the
discretion of management per incident by mail. All purchases made with O So Relaxed or staff are binding through
the admiration of your acceptance of our policies and procedures. All disputes will only be settled through
arbitration. Please contact us if you have any questions about the Appointment and Cancellation Policy 757-6569559.

Clients Signature: _____________________________________________________________Date:_________________