Client Intake form
Sage Thai Massage will not proceed with the session if the client refuses to wear a mask. If the client showed up to the session without wearing a mask and refuse to wear one that we provided ($5 fee for a mask) the session will treat as if "No show" and result in a 100% charge for the session without service.
PLEASE READ and agreed to the following and acknowledged before scheduling an appointment.
***Due to the Electronic health consent form, the name of the person who will receive the treatment must matched with the name that appear through the online scheduling and credit card on file (No exception please, including the spouse or any family member) unless the person is underage.***
1. The therapist and the clients will be wearing appropriate PPE (Personal Protective Equipment) the whole time before, during, and after the session.
2. If the client show up with the body temperature is higher than 98.6 F the session will be treated as no show.
3. Clients need to wear an appropriate MASK in the clinic at all times. The massage therapist will be wearing MASK and/or GLOVE and other PPE gears necessary suggested by the CDC and Health Department.
4. For the client's safety, for those who have traveled outside the country within 3 weeks, have any suspicious related symptoms and/or have pre-conditions and vulnerable to contracted the COVID-19
PLEASE "DO NOT" schedule any appointment at this time.
5. All sessions ( Deep tissue or Traditional Thai Massage) the client will be wearing comfortable loose fitting clothes and is the client responsibility to bring their own. No oil or lotion will be used. If the client show up with inadequate wear and violated draping ethic, the session will be treated as no show.
Sage Thai Massage
851 W.SR 436 Suite #1045
Altamonte Springs, FL 32714
407-788-7243
Initial
1. _______ My temperature has not been above 98.6°F in the past 72 hrs.
2. _______ I have not knowingly been in contact with anyone diagnosed
with Covid-19 in the past 2 weeks.
3. _______ I have not had any of the following symptoms in the past 2 weeks:
Fever, Cough, Shortness of Breath, Persistent Chest Pain, or Pressure.
4. _______ I acknowledge I am receiving Massage Therapy knowing
that social distancing cannot be adhered to during my massage session.
5. _______ In the event I contract Covid-19, I will notify my therapist as soon as possible.
COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing. Your Massage Therapist has put in place preventative measures to reduce the spread of COVID-19; however, your massage therapist cannot guarantee that you will not become infected with COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by receiving massage therapy and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my massage therapy appointment. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless my massage therapist, their massage establishment, and any interested parties from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of my massage therapist or the establishment where massage therapy services are received, whether a COVID-19 infection occurs before, during, or after participation in any massage therapy session.
____________________ ____________________
Client Signature LMT Signature
Date ________________ Date ________________
To book an appointment online you are agreeing to the terms and conditions as follows.
Change of clothes to wear for Traditional Thai Massage and draping with sheets for deep tissue massage is no longer available at the clinic. (Both massage type is performed with the client wearing comfortable loose-fitting cloth)
Please bring your own or wear comfortable loose-fitting cloth for the session. The massage therapist will not treat the unclothing client and the session will be treated as a no-show.
Both Deep tissue massage and Traditional Thai Massage here at Sage Thai Massage are performed without oil or lotion.
*Please note* If your muscles and skin are super sensitive when getting the treatment without lubricant, my practice might not be for you.
All Payments will be completed at the end of the session. The credit card on file is only used to reserve the appointment and will not be charged unless no-show or less than 24hr cancellation. Exceptions must be pre-authorized.
For pre-paid with a gift certificate, it must be print out (including in case of using PayPal email transaction); includes the full value of said gift certificate, name, and the email of the sender, and will be forfeit in the event of a no-show, late cancellation, late notice of rescheduling as outlined above.
The gift certificate is not refundable but transferable.
Please arrive 5 minutes before the session time.
Please note that the door is always locked and will be open 5 minutes before the session.
Cancellation of any appointment required to be done through the "Schedulicity" online booking system only (message over the phone or email is not accepted and subjected to cancelation policy state on the website) Cancelation link can be found on the bottom page of the email confirmation.
COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing. Your Massage Therapist has put in place preventative measures to reduce the spread of COVID-19; however, your massage therapist cannot guarantee that you will not become infected with COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by receiving massage therapy and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my massage therapy appointment. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless my massage therapist, their massage establishment, and any interested parties from the Claims, including all liabilities, claims, actions, damages, costs, or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of my massage therapist or the establishment where massage therapy services are received, whether a COVID-19 infection occurs before, during, or after participation in any massage therapy session.
Late Arrivals
If you arrive late, your session may be shortened in order to accommodate others whose appointments follow yours. Depending upon how late you arrive, your therapist will then determine if there is enough time remaining to start a treatment. Regardless of the length of the treatment actually given, you will be responsible for the “full cost” of the cost of the session. Out of respect and consideration for your therapist and other customers, please plan accordingly and be on time.
Consent
If I experience any pain or discomfort during the 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 Therapy 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 specialists for any mental or physical ailment of which I am aware. 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. This is a Therapeutic Massage session and any sexual remarks or advances will terminate the session and I will be liable for payment of the scheduled treatment. I understand the Massage Therapist practitioner reserves the right to refuse services to me for any reason that she deems necessary.
Online scheduling can be made on the "online scheduling" menu