Kara Lawson, RMT Terms of Agreement

I hereby acknowledge that a minimum of twelve hours notice must be given prior to any cancellation and that
failure to do so will result in a fee of half the service price. I am also aware that fail to show for the appointment
completely will result in a fee equal to that of the service scheduled. I understand that all charges must be paid
prior to booking any further appointments, and that any and all cancellations must be done by phone call only.

I acknowledge that I have stated all of my known medical conditions, and that the information I have provided on
this form is correct and current to the best of my knowledge. I acknowledge that I have consulted a medical doctor
or licensed medical health care practitioner regarding any of the checked/described conditions. I understand that it
is my responsibility to inform the massage therapist of any changes to this information and the practitioner shall not
be liable should I fail to do so.

I hereby consent for my therapist to treat me with massage therapy for the noted purposes including such
assessments, examinations and techniques, which may be recommended, by my therapist. I acknowledge that the
therapist is not a physician and does not diagnose illness or disease or any other physical or mental disorder. I
clearly understand that massage therapy is not a substitute for a medical examination, and that it is recommended
that I attend my personal physician for any ailments that I may be experiencing. I acknowledge that no assurance or
guarantee has been provided to me as to the results of the treatment. I understand that all massage therapy offered
is strictly professional and that upon the occurrence of any inappropriate behavior, the massage will be terminated.
If at any point during the massage I am uncomfortable or uneasy with the procedures being administered and/or if I
experience pain, I understand it is my responsibility to IMMEDIATELY inform the massage therapist, so that the
massage can be terminated or the strokes and pressure can be adjusted to a level of comfort.

I understand that it is contraindicated for me to book or attend a massage therapy session with any of the following
conditions: fever, contagious diseases, (including any cold or flu no matter how mild it may seem) under the
influence of drugs or alcohol, (including prescription pain medication) recent operations or acute injuries, neuritis,
or skin diseases. Should I fail to inform my therapist prior to my session, I also understand that I will be denied
treatment and asked to leave the clinic.

*Email/Text Policy: Please note, your email address is used for appointment reminders, to notify you of promotions
and occasional office news and for the distribution of forms and sales receipts. Your cell phone number is used for
communication regarding appointments. Your privacy is important, I will not sell, rent or give away your name,
address, or contact information to anyone. Please notify me directly at karalawsonrmt@shaw.ca, if you no longer
wish to receive text messages or email communication.

I have read and fully understand the above and have received the policy statement and have read and agree to the
policies therein.

Date: _________________________ Signature: __________________________________________

Freedom of Information and Protection of Privacy: The information that you provide on
this document will be used for facilitating your treatment only. We treat your personal
information with respect and care and use it to serve you better. Your personal
information is protected by Alberta's Freedom of Information and Protection of Privacy
Act and can be reviewed on request. If you have questions about the collection and
use of this information, please ask your massage therapist.