Samadhi Bodywork Consent Form

I understand that the bodywork I receive is provided for the basic purpose of one or more of the following: opening and aligning the physical structure, releasing muscular tension, resolving trauma in the nervous system, harmonizing the flow of energy in the body, and opening awareness through the body. If I experience any pain, discomfort or the therapist’s pressure is over my level of tolerance, I will immediately inform the therapist. I further understand that bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or other qualified medical specialist for any mental or physical ailment that I am aware of. 

I understand that non-chiropractic practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapist’s part should I fail to do so.

I understand that the healing relationship between practitioner and client is non-sexual and strictly therapeutic in nature. The practitioner shall provide a professional, non-flirtatious environment for each client. The practitioner reserves the right to terminate the healing relationship for any reason.

I understand that I am responsible for showing up on time for any scheduled session.  I understand and agree to the following working contract policies: 

Session Cancellations:  Cancelling 48-24 hours before session, I am responsible for 50% of the scheduled session fee.  Canceling or no-showing 24-0 hours before session, I am responsible for 75% of the session fee.  The second cancellation under 24 hrs I am responsible for 100% session fee.  Missed appointments within a package series count as used sessions.

I understand that purchases for session packages are final, unless cancellation has been made within 24hrs of purchase.

I understand it is my responsibility as client to initiate the scheduling process for the booking of sessions within a multiple session series.  Session credits are valid 6 months from the date of purchase.

I understand that I am responsible for the full scheduled session fee at the beginning of the session, unless other payment arrangements have been made.  Sessions can by cash, check, credit card, or electronic transfer (Paypal, Stripe, Square).

I understand this document is a legally binding contract. I understand that if I choose to sign this document electronically and turn it in electronically (by email), I am fully responsible for cooperation with the procedural policies and agreements stated on this form.