The Health History form is required by law and includes my policy statement.  This is to ensure a safe and positive massage experience for you.  

You can print it, fill it out and bring it with you, 
or wait until your appointment to fill out a copy I will provide for you.
N.C. Lic. #8524

Your Rights:
- All information, therapeutic discussions, casual conversations, records, either written or 
  verbal during your visits, will be kept confidential.
- Your comfort and level of modesty are of the utmost importance. 
- You have the right to discontinue treatment at any time, even during a session. 

My Rights:
- By law, I have the right to refuse treatment and to immediately terminate a treatment if a 
  • is abusive, under the influence of alcohol or drugs, or is otherwise impaired; or
  • behaves in a way that I perceive to be sexual in nature.
- You are required to be draped, and sometimes minimally clothed, depending on the type of 

Late Arrivals, Cancellations and No-shows:
- If you are late you will pay full price for the session, but I will try to  accommodate you 
  depending on my schedule.
- Please provide at least 24 hours notice of a cancellation or you may be responsible for the 
  cost of the session. One option is for you to send someone else in your place.  
- If you miss an appointment without notice, I reserve the right to decline future 
  appointment requests.