Client/Practitioner Agreement

We understand massage therapy does not include diagnosis treatment or prescription.
We understand this is a professional atmosphere, non-sexual in nature. AMTA-approved draping techniques will be used throughout the session.
We understand there is no problem with revising the schedule as long as notification is communicated at least 24 hours in advance. In the event that Practitioner or client does not provide 24-hour cancellation notice, they agree to the following:

• The Practitioner will reschedule a session, provided free-of-charge to the client.
• The client will pay in full for the missed session.

We understand our responsibility for personal hygiene prior to the massage session.
We understand the Practitioner will provide a safe, secure and supportive environment for the client. All information communicated both verbally and in writing, will be held in confidence by the Practitioner.
The client understands the session is a professional service for which they are paying.
The client has a say in the session and may stop the Practitioner at any time to revise or to clarify their needs. (time, temperature, pressure or bathroom break)
The client understands full payment is due upon completion of the session, in cash or check. There will be a $25 charge for returned checks, plus any additional bank fees incurred by the Practitioner.
The client understands the importance of notifying the Practitioner of any changes in their health status, to ensure the most effective and beneficial application of massage for their health enhancement.
The client also verifies that all information provided on intake forms is accurate and complete, to the best of their knowledge.

Client Signature                                                                    Date


Lori Marie Prior                                                                     Date
Licensed Massage Therapist