Sage & Stone Therapeutics

Client Intake & Wellness Questionnaire

Please answer each question honestly and completely. All information is kept strictly confidential and is used solely to ensure your care is personalized, safe, and professional.

"Professional therapeutic care. Personalized for your body. Delivered to your door."

Mobile Massage Appointment Agreement

• I confirm that a safe, clean, smoke-free environment will be provided for my massage session.

• To ensure the safety of both the client and therapist, I understand that massage services must be performed on the ground (first) floor of the residence.

• I understand that Sage & Stone Therapeutics reserves the right to refuse or discontinue services if the environment is unsafe or if inappropriate behavior occurs.

• I understand that no illegal drugs, excessive alcohol use, or sexual conduct will be permitted during any appointment.

  
  

Cancellation & Payment Agreement

• I understand that payment is due when my appointment is scheduled and confirmed.

• I understand that if I choose to cancel my appointment after it has been confirmed, 50% of my payment will be retained as a cancellation fee. The remaining 50% will be refunded, and I may reschedule for a future appointment.

• I agree to these policies.

Client Consent & Acknowledgment

By signing below, I acknowledge and agree to the following:

• I voluntarily consent to receive massage therapy and therapeutic bodywork provided by Sage & Stone Therapeutics.

• I understand that massage therapy is intended to promote relaxation, relieve muscular tension, improve circulation, support mobility, and enhance overall well-being.

• I understand that massage therapy is therapeutic in nature and is strictly professional and non-sexual. Any inappropriate comments, gestures, or behavior will result in the immediate termination of the session, and I may be refused future services.

• I understand that my massage therapist is a licensed massage therapist and does not diagnose illnesses or medical conditions, prescribe medications, perform spinal manipulations, or provide medical treatment.

• I understand that massage therapy is not a substitute for medical care, chiropractic care, physical therapy, or mental health treatment, and I am encouraged to consult a qualified healthcare provider regarding any medical concerns.

• I agree to inform my massage therapist of any medical conditions, injuries, surgeries, medications, allergies, pregnancy, or changes in my health that may affect my treatment.

• I understand that I may request changes to pressure, techniques, positioning, or discontinue the massage at any time for any reason.

• I understand that my massage therapist reserves the right to refuse or discontinue treatment if it is determined that massage is contraindicated or if client behavior is inappropriate or unsafe.

• I understand that while massage therapy offers many potential benefits, no guarantees have been made regarding the results of any treatment.

• I certify that the information I have provided on my health intake form is accurate and complete to the best of my knowledge.

By signing below, I acknowledge that I have read, understand, and voluntarily agree to the statements above and consent to receive massage therapy from Sage & Stone Therapeutics.