Common Contracts
1 similar Client Intake Form contracts
Information AgreementClient Intake Form • November 3rd, 2021
CONTACT INFORMATIONTo Be Completed By Client Name Mobile Phone Number OK to leavemessage I would like to receive text notifications regarding my account, including (but not limited to) appointment confirmations. (Messaging & Data Rates may apply)I would like to receive promotional e-mail, phone calls, text messages, faxes, and other electronic messages for Elements Massage, including gift card offers, etc. (Messaging & Data Rates may apply) Address City/State Zip Email Address Date of Birth Emergency Contact Name & Phone Number ELEMENTS MASSAGE® POLICIESPlease review and check each box. (Please ask us if you have any questions, concerns or need additional information): I may undress to my comfort level. I will be properly draped, meaning covered by the sheet and/or blanket at all times. The therapist will only uncover the part of the body that is being worked on during the massage session.As further explained below, the therapist reserves the right to terminate the session at any t
