Name *

First Name

Last Name

Phone *

(###)

###

####

What services are you interested in? *

Massage

Dry Needling & Cupping

Massage with Dry needling &/or cupping

Preferred Date *

MM

DD

YYYY

Preferred Time *

Hour

Minute

Second

AM PM

Terms & Conditions *

By booking or receiving Massage, dry needling, cupping, or other practitioner services, you ("Client") agree to the following: Informed Consent: You understand the nature, benefits, and risks of the services and voluntarily consent to treatment. Medical Disclosure: You must provide accurate medical information. Failure to disclose relevant details may impact the treatment’s safety or effectiveness. Not Medical Care: Services are not a substitute for medical advice or treatment. Consult a healthcare provider for medical concerns. You will not be seen if you have/are any of the following: Blood conditions/on blood thinners, skin conditions or frail skin, cardiovascular conditions, Vascular conditions (eg DVT), infections, on anticoagulants, pregnant. Assumption of Risk: You accept responsibility for any outcomes, including common side effects (e.g., soreness or bruising). Payment & Cancellation: Payment is required at the time of confirming booking. There will be no refunds accepted for any reason, including cancellation or no shows. Liability Waiver: To the extent permitted by law, you release the Practitioner from liability, except for gross negligence. By proceeding, you confirm understanding and acceptance of these terms.

I have read, Understand, and agree to the above statements

I don't understand, and I don't agree