Massage Therapy@Home

A traveling therapeutic massage business

Rockford, Illinois

(815) 669-0475

Massage Therapy@Home is a traveling therapeutic massage business serving the Greater Rockford Area.

Consent Form 

 

 I UNDERSTAND THAT AT ANY TIME THE MASSAGE THERAPIST OR I HAVE THE RIGHT TO STOP THIS AND/OR FUTURE MASSAGES.

I understand any inappropriate behavior or remarks will result in the immediate end of my massage and that it can and WILL be prosecuted to the full extent of the law.

  • I understand that the massage I receive is provided for the basic purpose of relaxation, stress reduction, and relief of muscular tension.  I further understand that the massage should not be considered as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for mental or physical ailment that I am aware of.
  • I understand that massage therapists are not qualified to perform skeletal adjustments, diagnose and/or prescribe, and that nothing said in the course of the session should be construed as such.
  • Because massage can negatively affect the body under certain 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 forget to do so.
  • I will let the massage therapist know if the pressure to too firm or if it is not enough. 
  • I understand the rate of my massage may change without notice and I am expected to pay the full price at the time of my appointment.

Changes In Booking Fees

I will be charged a $20 fee for less than 2 hours notice of appointment cancellation, a major change in booking, or a no-show.