• Client Intake Form

    Please tell us a bit about yourself

    All information is confidential, at no given point is information disclosed or shared without client’s written consent

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  • Certain medical conditions or symptoms may be aggravated or get worse by receiving a massage. A referral from your primary care provider may be requested before your session. You are encouraged to check with your doctor to be sure massage therapy is appropriate for you. This includes musculoskeletal,circulatory, respiratory and skin conditions. If your condition is not below please mark other and advise.

  • Are you currently experiencing symptoms of any of the following conditions? If you currently are ill your session MUST be rescheduled for 48 hours after symptoms subsides. To protect the health of our clients and team members we reserve the right to refuse treatment to anyone that is ill.


  • Massage Policies:

    Client services and chart information are confidential. Written authorization is required from you to release any information.

           • Please turn off your cell phone for optimal relaxation

           • Your scheduled session is set aside for you. We do not double book appointments

           • Please arrive 10 minutes before your schedule time of appointment

           • 12 hour cancellation notice is required to avoid being charged for your session

           • Per Georgia law you will be draped and at no time will genitalia or breast tissue be exposed

           • You will have a brief consultation with your therapist to discuss your session

           • After your therapist has left the room, you may disrobe to your comfort level

           • I understand that my Massage Therapist or I may end the session at any time for any reason

           • Inappropriate behavior will not be tolerated and may be prosecuted to the full extent of the law


    Client Agreement:

    I understand that Massage Therapists do not diagnose, prescribe or replace the treatment or advice of a physician,

    nor do they perform any spinal manipulations. I acknowledge that the massage therapy received at Aequilibria Massage studio

    is for therapeutic reasons such as reducing stress and muscular tension only and is not a substitute for medical

    treatment. I understand that it is recommended for me to see a physician for any physical, mental or medicinal need 

    and I am encouraged to inquire about massage therapy being safe for any of my conditions. I also understand that

    at any time I feel pain or discomfort during the session, I will immediately inform my Massage Therapist so they can

    adjust the pressure to my comfort. I have informed my Massage Therapist of all known medical conditions and

    understand it is my responsibility to keep my Massage Therapist updated on my physical health. 

    I understand that my failure to do so may pose a threat to my health and/or physical well being and I hold

    harmless Avani Massage and my Massage Therapist from any liability whatsoever arising from failure on my part.

    By my electronic signature below, I agree to the massage policy and client agreement above.

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