I understand that this appointment is scheduled for MYSELF only. Any appointments scheduled for other people under your account will be removed/canceled.

I understand that massage is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow.

If I experience pain or discomfort during the session, I will immediately inform Jillian (owner), so that pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.

I understand that if I feel uncomfortable or exposed, I will immediatley let Jillian (owner) know. My number one goal is making you feel safe and comfortable at ALL times.

I understand that the services offered today are not a substitute for medical care. I understand that Jillian (owner), is a CMT and not qualified to accept insurance or perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness.

I affirm that I have notified Jillian (owner), of ALL known medical conditions and injuries.

I agree to inform Jillian (owner), of any changes in my health and medical condition and will update my Intake Form accordingly. I understand that there shall be no liability on the therapist’s part should I forget to do so.

I understand that massage is entirely professional and non-sexual in nature. Any solicitation of sex will be immediately reported to authorities.

By signing this release, I hereby waive and release Jillian (owner), from any and all liability, past, present, and future relating to massage therapy and bodywork.

I undertand appointments can be booked online and a non-refundable 50% deposit is required to secure an appointment. A secure credit/debit card must be saved on file. Invoices for deposits must be paid 1 hour after being sent or appointment will be canceled.

I understand I MUST COMPLETELY fill out an Intake Form prior to scheduling appointment. If forms are not completed 24 hours before appointment, your massage will be canceled.

Please arrive only 10 minutes prior to your appointment, unless discussed. If you are running late, please send a message to inform me and I will do my best to accommodate. Appointment times are reserved for each client, so oftentimes I cannot exceed your reserved time without making my next client late. For this reason, arriving after your appointment time may result in loss of time from your massage so that your session ends at the scheduled time. Appropriate time is also needed in between appointments to properly disinfect and sanitize.

I understand that there must be 24 hours of notice for cancelations or changes. All clients receive a reminder text and email 48 hours before scheduled appointments (enough time to reschedule online before 24 hours). Please understand that when you cancel or miss your appointment without providing notice, I am often unable to fill that appointment time. This is an inconvenience to your Therapist and also means other clients miss the chance to receive services they need. In order for me to reserve a place in my schedule for you, it is required that you agree to my cancelation policy.

I understand that I must personally contact Jillian for cancelations or rescheduling. As long as you are rescheduling within 24 hours, you can change your appointment time through your account. Do not cancel or reschedule through FB or IG messages. Personally send a text at 302-893-8533. Automated text messages are not to be replied too. It is an automated number and I will not receive replies. Please personally contact me!

Appointments 15 minutes late will be considered as a no-show and charged 100% of service (card on file will automatically be charged). Please know it is not intended to penalize you - this is part of the agreement you are making with my business to help me protect my ability to serve you and all my clients.

Cancelations less than 24 hours notice will automatically be charged as late, resulting in use of deposit. Please know it is not intended to penalize you - this is part of the agreement you are making with my business to help me protect my ability to serve you and all my clients.

Cancelations 4 hours or less before scheduled appointment time will be charged 100% of service (card on file will automatically be charged). Please know it is not intended to penalize you - this is part of the agreement you are making with my business to help me protect my ability to serve you and all my clients.

I understand not showing for an appointment will automatically result in 100% charge of scheduled service. If only paid a 50% deposit, card on file will automatically be charged for remaining balance. Please know it is not intended to penalize you - this is part of the agreement you are making with my business to help me protect my ability to serve you and all my clients.

I understand that trying to reschedule an appointment with less than 24 hours notice will result in use of deposit.

I understand that trying to reschedule an appointment with less than 4 hours notice will result in use of deposit and charged the remaining balance with card on file.

I undertsand invoices will be sent if canceling less than 24 hours or no showing with pre-paid appointments/credits. Pre-paid credit amount will be put back into your account and can be used once the invoice is paid. Please know it is not intended to penalize you - this is part of the agreement you are making with my business to help me protect my ability to serve you and all my clients.

I understand appointments and deposits on client accounts are not transferable. If you are unable to make your scheduled appointment, please do not send someone in your place.

I understand that if I am considered high-risk, I will let my Therapist know.

I understand that I will provide a Doctors release for high-risk pregnancy.

I understand that I will let my Therapist know of any medical changes as soon as possible.

Massage therapy during pregnancy has been shown to be beneficial for a number of common complaints such as fatigue, musculoskeletal pain, sciatica, edema, and many others. However, there are risks associated with specific conditions that may occur during pregnancy.You must inform your massage therapist/practitioner if you have or have had in the past any of the following conditions or symptoms which may make massage therapy during pregnancy contraindicated or may require your therapist/practitioner to alter the massage:

1. History of miscarriage
2. Gestational Diabetes
3. Cardiac, pulmonary, liver, or renal disorders
4. Pitting edema
5. Epilepsy or other convulsive disorders
6. Placental or cervical dysfunction
7. Abdominal pain
8. Leaking of amniotic fluid
9. Fever
10. Sudden edema/swelling
11. Severe headaches
12. Preeclampsia
13. Drug exposure
14. Multiples
15. Hypertension
16. Genetic abnormalities
17. Bloody discharge
18. Decrease in fetal movement over 24-hour period
19. Severe nausea or vomiting

I have discussed with my prenatal healthcare provider/physician any health concerns that I had about receiving massage therapy. I agree that my healthcare provider/physician has given me clearance to receive massage therapy.

I understand the information contained on this form and confirm that (1) I am receiving medical care including regular check-ups with a licensed healthcare provider. (2) I have not experienced any of the listed symptoms, conditions, or complications. (3) I am not currently experiencing any of the listed symptoms, conditions, or complications. (4) I am experiencing a low-risk pregnancy.

I understand that I will be receiving massage therapy as an adjunct form of healthcare only and that this therapy is not meant to replace appropriate medical care. I release the massage therapist/practitioner of all liability for any harm that may unintentionally occur during my treatment(s).

Cautions and Contraindications for Postnatal:

1. Deep Vain Thrombosis
2. Mastitis
3. Edema/Swelling
4. Uterine Infection
5. Uterine Bleeding

Cupping is not suitable for everyone. There are risks associated with performing cupping therapies on individuals with the following conditions. You must inform me if you have any of the following conditions which may make cupping contraindicated or may require to alter the treatment: prescription blood thinners, liver or kidney disease, at risk of stroke, bruises, pregnancy, blood clots, cadiovascular disease, neuropathy, autoimmune conditions, peripheral vascular disease, heat sensitivity, compromised immune system, edema, lymphedema, diabetes, inflammatory skin conditions, open wounds, sores, thinning skin, hypotension, hypertension, cancer (on chemo or radiation), varicose veins, under influence of drugs/alcohol.

Hydrate. Water is essential for your health, especially for your lymphatic system. Cupping supports your lymphatic system. Your lymphatic system clears away cellular waste from your body and it needs plenty of water to do this effectively.

Eat an hour or so before your appointment.

Don’t shave the area within four hours of your appointment. Your therapist really doesn’t mind stubble and your skin will thank you.

Recover from sunburn. When you receive cupping, it will feel like that area is warmer than normal. Neither the cup nor the extra heat will feel good on sunburned skin. Apply some soothing aloe and wait until your skin has recovered before your next cupping appointment.

Don’t exfoliate aggressively. Exfoliating removes a layer of dead skin, which makes your skin extra sensitive. Wait a couple days after aggressive exfoliation treatment before receiving cupping.

4-6 hours post cupping: avoid hot showers, saunas, hot tubs and strong air conditioning. After cupping your skin will be more sensitive to temperature in the areas where the cups were placed.

I understand that I will be receiving cupping as an adjunct form of healthcare only and that cupping is not meant to replace appropriate medical care. I understand the risks of bruising and muscle soreness that may occur directly or indirectly from cupping treatment. I release the massage practitioner and business of any and all liability for any harm that may unintentionally occur during my treatment(s).