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Spiritual Warrior Woman

Trauma Touch Therapy Intake Form

Please complete the form below after booking your appointment. We offer a safe and secure system and your privacy is of the utmost importance to us. For more information, visit our privacy policy.

May a message be left?
Abuse History (Mark al that apply)
Degree of Abuse (Choose one)

FOR YOUR INFORMATION:
As a Trauma Touch Therapist, I am not qualified to make any diagnosis or prescribe any treatments. All recommendations are to be viewed as suggestions. All sessions are confidential. Please see my Notice of Privacy Practices. All sessions are strictly non-sexual in nature. Client remains fully clothed during sessions.
 

CLIENT RESPONSIBILITY AGREEMENT:
I agree that I am responsible for my well-being while participating as a TTT (TRAUMA TOUCH THERAPY).

 

I agree to be responsible for my participation in, and creation of, this therapy.
 

I agree to take responsibility for my truth, my feelings and needs, and whatever issues arise for
me, and ask for support when necessary.
 

I am willing to have learning transformation happen in ways that are totally loving and kind to me and everyone else.

Thanks for submitting!

Spiritual Warrior Woman

Myofascial Release and Bodywork Intake Form

Please complete the form below after booking your appointment. Our system is safe and secure. Your privacy is of the utmost importance. For more information, visit our privacy policy.

May a message be left?
May a message be left?

History / Myofascial Release Session Information

Have you ever recieved myofascial release?
Are you currently under the care of a health care practioner?

Previous History (include year and treatment received)

Please mark any of the following you now have or have had

Musculoskeletal
Circulatory
Respitory
Skin
Nervous System
Digestive
Reproductive
Other

I have completed this form to the best of my knowledge and will inform the MFR therapist of any changes in my physical health.


I understand that a Massage or MFR Therapist can not diagnose illness, disease, or any other medical, physical, or emotional disorder, nor perform any spinal manipulations. I am responsible for consulting a qualified physician for any physical ailments that I have. I understand that Myofascial Release is a therapeutic treatment and is non-sexual in nature.


I understand that if my therapist starts a session late, she will make it up to me at the end of my session if possible or add it to my next session or reduce my fee accordingly. I understand if I arrive late, my session will end at the originally scheduled time so the client following me is not penalized. I agree to give 24-hour notice to cancel a session. I am aware that I will be charged the full fee for any missed sessions or for sessions that I do not give 24-hour notice to cancel or reschedule.

Thanks for submitting!

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