First Time Client

Intake Form

All information is held in the strictest confidence. At no given point this information is disclosed or shared without client’s written consent.

You may choose to skip answering any non-require question you feel impinges on personal information you do not wish to disclose.

Intake Form

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Client services and chart information are confidential. You will have a consultation with your therapist to discuss your session. I understand that the massage therapist or I may end the session at any time for any reason. Inappropriate behavior will not be tolerated and will result in the immediate termination of the massage and the full amount of the service will be charged.
Client Agreement: I understand that therapeutic massage therapists do not diagnose illness, disease, any physical or mental disorder, nor do they prescribe medical treatment, pharmaceuticals, or perform joint mobilization. I acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that a physician be seen for that service. It is my choice to receive therapeutic massage as a form of therapy for relaxation. I understand that if at any time I feel pain or discomfort during the session, I will immediately inform the massage therapist so he/she may adjust the pressure. I have stated my pertinent medical conditions, and will update the massage therapist of any changes in my health status. I understand that my failure to do so may post a threat to my health and/physical well being and I hold harmless Island Massage by Daniel and my massage therapist from any liability whatsoever arising from failure on my part. By my electronic signature below, I agree to the massage policy and client agreement above.