By signing below, you consent to treatment and agree to the following:
If I experience any pain or discomfort during this session, I will immediately inform Bonnie so that she can adjusted to my level of comfort. I understand that deeper bodywork may result in sore muscles or tenderness following the massage and will contact Bonnie if I feel I am excessively sore or in pain. I can end the session at any time without giving a reason. If I am dissatisfied with the services, I can discuss this with Bonnie for modification of treatment or refund. I further understand that massage should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand that massage practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said during the session should be construed as such. Because massage/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 Bonnie updated as to any changes in my medical profile and understand that there shall be no liability on her part should I fail to do so. Bonnie will keep our work together confidential with the exception of these special situations: if she believes I am in imminent danger of hurting myself or another person; a child, elderly or disabled person is being abused; she is presented with a legitimate court order to present testimony in a legal proceeding; if I fail to pay for services requiring action to collect fees due. I may direct Bonnie to share information with whomever I choose and can change my mind and revoke that permission at any time. I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.
Sessions may be paid for by personal check, cash, or credit card. Credit card payments are processed through square and I will charge you the 2.75% fee if you choose this method of payment. Payment is expected at the time of service, unless previous arrangements have been made. Allow 24-hour notice for rescheduling or canceling an appointment. 50% of the fee will be due if cancellation occurs within 24-hours of appointment and the full fee will be charged for missed appointments without any notification. If arriving late results in the session starting late, the session will still end at the scheduled time.
Hold Harmless Agreement
I hereby agree to indemnify and hold harmless Bonnie Eason and Bonnie Be Bodywork, LLC from any loss, liability, damage or cost they may incur due to any claim made against her arising from the provision of therapies to me, or in any way resulting from, arising in connection with, or related to any therapies performed by her to me.
Understanding all of this, I give my consent to receive care.
