SWIM FASTER, BIKE FARTHER, RUN HARDER, REST, FEEL BETTER
MASSAGE THERAPY FOR THE ACTIVE CLIENT
Optimal Performance Massage
Disclosures and Sexual Misconduct
You will be asked to sign a required intake form during your visit to the office.
In accordance with the Georgia Massage Therapy Practice Act, proper draping protocols will be enforced to provide safety, comfort, and privacy for both the client and therapist. Clients’ boundaries regarding privacy and physical exposure will not be violated. Refusal to respect and agree to these terms will result in the immediate termination of the session with full payment owed regardless of time lost. This point is non-negotiable.
Sexual misconduct is expressly forbidden. Client understands that any illicit or sexually aggressive remarks, advances or gestures will result in the immediate termination of the session and client will be responsible for the full payment of the session. Additionally, local law enforcement may be alerted based on the offense. OPTIMAL PERFORMANCE MASSAGE HAS A NO TOLERANCE POLICY FOR INAPPROPRIATE BEHAVIOR.
Client Consent to Treat
It is 'my' choice to receive massage therapy. I am aware of the benefits and risks and give my consent for massage. I understand that there is no implied or stated guarantee of success or effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status. I understand that a Licensed Massage Therapist does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage therapy. I will participate fully as a member of my healthcare team. I will make sound choices regarding my sessions’ plan based upon the information provided by my massage therapist. I agree to communicate with my practitioner any time I feel my well-being is being compromised. I expect my practitioner to provide safe and effective treatment to the best of his/her skills.
Assignment of Benefits
I am responsible for all charges for all services provided. In the unfortunate event that my insurance company denies payment through my HSA/FSA, or makes a partial payment, I am responsible for any balance due.
Release of Medical Records
I authorize the release of medical records or other health care information, including intake forms, chart notes, reports, correspondence, billing statements, and other written information to my attorneys, healthcare providers, and insurance case managers, for the purposes of processing potential claims in the unlikely event of a workman's compensation claim, auto accident, or other settlement based claim.