BY BOOKING ANY SERVICE, YOU ARE AGREEING TO THESE TERMS
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Available by appointment ONLY.
Please book online to reserve your appointment.
First session includes a 10-15 minute consultation (If serious health condition is present), this period is NOT counted towards your timed session. Please arrive 15 minutes before session.
Failure to show without notice within 30 minutes of appointment, 100% of service price will be charged.
SAFETY GUIDELINES:
Masks are optional by highly recommended.
Hand sanitizer available for use prior to entry and throughout our facility.
Hepa filtration systems are in place with each room having its own additional air filter.
Our lounge is thoroughly sanitized between clients including payment touch screens (online booking and no touch payment availability on site and on website)
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Compression Therapy Informed Consent
Compression therapy is a non-invasive modality proven to increase circulation and range of motion, reduce pain and
soreness, boost pressure to pain threshold and clear lactate and metabolites from the limbs after physical activity.
This modality pairs compression with a sophisticated massage pattern, employing three key forms of biomimicry, including
pulsing, gradients, and distal release.
• The pulsing action uses dynamic compression, effectively mimicking the muscle pump of the legs and arms, to greatly
enhance the movement of fluid and metabolites out of the limbs.
• Hold pressures are used, similar to the one-way valves of veins and lymphatic vessels, to prevent fluid backflow, and
enhance the natural circulatory flow.
• The distal release feature releases hold pressures once they are no longer needed, ensuring that each portion of the
limb gains maximal rest time without a significant pause between compression cycles.
Once you are set up on the devices, you will first experience a pre-inflate cycle, during which the attachments fill with air to
calibrate and mold to their exact body shape. The session will then begin by compressing your feet or hands (depending on
which attachment you are using). Similar to the kneading and stroking done during a massage, each segment of the
attachment will first compress in a pulsing manner and then release. This will repeat for each segment of the attachment as
the compression pattern works its way up the limb. This stimulates blood flow, massages the muscles, and works in harmony
with the body’s circulatory system to mobilize fluid out of the extremities and back up towards the heart.
Consent Form For Steam Tent Treatment
Heat experienced during a Steam Tent treatment speeds up the chemical processes in the body, making it one of the most simple and comfortable ways to rid the body of accumulated toxins. As the pores open up and the million of sweat glands start to excrete, the body rids itself of metabolic and other waste products. Sweat contains almost the same elements of urine, as for this reason the skin is sometimes called the third kidney.
Regular sweating can help detoxify your body as it rids itself of an accumulation of carcinogenic metals (lead, mercury, zinc, nickel and cadmium) as well as alcohol, nicotine, sodium, sulfuric acid and cholesterol.
Contraindications regarding Steam Therapy
Do not receive steam therapy if you pregnant.
Due to the increase in cardiovascular activity brought on by heat, steam therapy is not recommended for those who have high blood pressure, heart disease, or other cardiovascular problems.
Do not receive steam therapy if you are extremely frail, sick or elderly.
Do not receive steam therapy if you under influence of non-prescription substances.
If you have a doubt about your health, we suggest that you obtain your doctor’s permission to receive steam treatments.
By booking an appointment, you are agreeing that you do NOT have any of the following contraindications and have read about and understand this treatment. *
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INFRARED SAUNA AGREEMENT/ACKNOWLEDGEMENT
It is always important to maintain proper hydration levels during far infrared therapy. Dehydration will
increase carbohydrate utilization and cause less fat to be burned for energy. We highly recommend drinking
a minimum of 8 oz. of water prior to entering the sauna and a minimum of 8 oz. of water after sauna use.
1. The use of drugs, medication or alcohol prior to or during the full spectrum infrared sauna session
may lead to dizziness or unconsciousness. Clients using any medications must consult a physician
or pharmacist prior to the use of the sauna.
2. Please consult your physician if you are in doubt of your ability to use the full spectrum infrared
sauna for health reasons.
3. No one under the age of 18 is permitted in the full spectrum infrared sauna unless accompanied
by a supervising adult.
4. Discontinue the use of the sauna if you feel light-headed, dizzy, or heat exhausted.
5. Sauna sessions should be limited to no more than 45 minutes and temperatures must stay below
150 degrees Fahrenheit.
6. Plastic water bottles are not permitted in the sauna.
7. Clients using any medications must consult a physician or pharmacist prior to the use of the sauna.
8. Pregnant women should consult their physician prior to the use of the sauna. Excessive body
temperatures have a potential for causing fetal damage during the early days of pregnancy.
I acknowledge and voluntarily assume the risk of injury, accident, or death which may arise from the use
of an infrared sauna. I, and any of my heirs, executors, representatives, or assignees hereby release all
claims or liabilities for personal injury or property damages of any kind sustained while on the premises,
during the use of the full spectrum infrared sauna and from any advice provided by an employee,
independent contractor, or any representative. I agree that this Application and Waiver is in effect for
all infrared sauna sessions and will not expire unless specifically requested by either party.
By booking an appointment you have agreed with the policy? *
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Massage Cupping Graston Consent Form
The Graston Technique is a form of manual therapy known as soft-tissue instrument-assisted mobilization, same as cupping. It is one of a number of manual therapy approaches that uses instruments with a specialized form of massage/scraping the skin gently.
The therapy is designed to help the practitioner identify areas of restriction and attempt to break up scar tissue.
Cupping and Graston (Scrapping therapy are similar in function, just a different approach)
Massage Cupping bodywork therapy is an adaptation of an ancient technique; the purpose of this
technique is to promote health and healing by: loosening soft tissue and connective tissue, scarring and
adhesions moving stagnation and increasing lymphatic flow and circulation. This therapy utilizes Auto Cupper or hard plastic cups and a vacuum pistol to create suction on the body surface. These cups are moved over the skin using gliding, shaking, popping and rotating techniques while gently pulling up on the cup, or may be parked for a short time to facilitate joint mobilization or soft tissue release. Suction reaches
deep into the soft tissue, attachments and organs. Another benefit is to pull toxins and inflammation
from the body to the surface of the skin where the lymphatic system can more readily eliminate them.
Potential reactions to Massage Cupping are temporary and may include:
o Discoloration due to toxins and old blood being brought to the surface
o Post tenderness: usually less than experienced from deep tissue work
o Redness and Itching: increased vaso-dilation and/or inflammation brought to
the surface
o Decreased Blood Pressure: due to vaso-dilation and/or nervous system sedation
Suggested after care recommendations:
 Drink plenty of water, to help eliminate toxins out of the body.
 Avoid showers, steam, sauna and exercise immediately following bodywork.
 Light stretching and range of motion exercises are beneficial.
 Exercise the next day will help increase circulation to aid in fading of cupping redness.
Contraindications:
People who are on blood thinners should not experience Massage Cupping. If you
start taking such medication please inform the therapist so your treatment plan can be
adjusted. If you are under the care of a doctor or acupuncturist, massage cupping could
potentially interfere with acupuncture treatments, and should be avoided.
· I understand that all treatments at this facility are therapeutic in nature. I agree to
communicate to the therapist any physical discomfort or draping issues during the session.
· Information has been provided to me about Cupping Therapy. If I choose to experience these
therapies during treatments, I understand the potential effects and after-care
recommendations.
· It has been explained to me that there are contraindications for Cupping Therapy. I have fully
disclosed all health factors to my therapist, including those not mentioned on my Massage
Health History Intake Form, to avoid any complications.
· It has been explained to me that there is the possibility of discolorations that can occur from
the release and clearing of stagnation and toxins from my body.
· I also understand that this reaction is not bruising, but due to cellular debris, pathogenic factors
and toxins being drawn to surface to be clear away by my circulatory systems.
· I further understand that the discolorations will dissipate from a few hours to as long as 2
weeks in some cases and in relation to my after-care activities.
· I understand that the first time I experience Cupping, my body’s immune system can
temporarily react to this release as it might with the flu-producing flu-like effects like, nausea,
headache, that will subside in time with rest and water. Water helps to dilute the intensity of
the releases.
· I understand that Cupping Therapy modalities should not be combined with aggressive
exfoliation, 4 hours after shaving, after sunburn or when I’m hungry or thirsty.
· I understand that I should avoid exposure to cold, wet and/or windy weather conditions, hot
showers, baths, saunas, hot tubs and aggressive exercise for 4-6 hours. I understand that
exposure to such extremes can produce undesirable effects and I should avoid such situations.
· I should consume an abundance of clean water.
CONTRAINDICATIONS TO CUPPING:
Acute and non-acute medical conditions
•Cancer, malignant tumors or while receiving cancer therapy
•Rheumatoid arthritis flare up
•Infection
•Fever
Cardiovascular-related conditions
•Aneurysms
•Hematomas
•Deep vein thrombosis
•Low blood pressure
•Acute circulatory disorders (varicosities)
Systemic Conditions / Weakened Conditions
•Diabetes
•Liver dysfunction
•Kidney dysfunction
•Hemophiliacs and clients who bruise easily
•Clients with extreme exhaustion, high stress or weakened general conditions
•Severe edema
Skin hypersensitivity-skin conditions to avoid include but not limited to
•Bruises
•Psoriasis
•Rash, Sunburn
•Shingles (Herpes zoster)
•Skin lesions, raised moles, skin tags, acne
•Medications – Including thin skinning medication
•Aspirin, Blood Thinners
All Acute musculoskeletal injuries
Medications
•Ask your doctor if cupping is contraindicated with any current medications you are taking.
•If you cannot reach you doctor, inform your massage therapist and we will consult with other resources.
CUPPING SPECIAL CONSIDERATIONS
•Pregnancy
It is recommended to introduce cupping gently in the second trimester. Recognize that a conservative approach is necessary as structures may be more responsive during pregnancy due to the hormonal changes in the body. Cupping will not be done lateral to the lumbar spine.
•Breastfeeding
It is recommended to express milk before cupping therapy to prevent exposing the infant to an altered breast milk taste following the treatment. It is advised to pump and dump the breast milk and feed the baby with the pre-cupping treatment expressed milk.
Children and the Elderly
• A gradual and gentle introduction of cupping therapy will be applied with children and the elderly. We will access the reaction to the treatment and adjust accordingly.
Note: Visible markings can result from cupping from 3 to up to 7-8 days following treatment. You must be comfortable with the markings, otherwise, cupping therapy is contraindicated.
I agree to allow the Cupping Practitioner to perform Massage Cupping. I also agree that I have read, understand and will follow all of the information above and will not hold the practitioner responsible. *
Type in First and Last name to complete agreement. *
Spine Relaxer Consent Form
What is the Spine Relaxer? It is an Intersegmental Traction or Roller Massage table with a heated jade to relax the muscles in your back.
This table helps in gently re-establishing the normal ranges of the body’s spine. Intersegmental traction table helps in relaxing the muscles and reducing the muscle spasms. Using the Spine Relaxer table promotes recovery and healing process from a back injury. The Spine Relaxer table or roller table allows changing the contact pressure of the roller either manually or electrically. The Spine Relaxer table is very beneficial in providing relaxation to a patient.
How Does Intersegmental Traction or Roller Table Work?
Spinal discs receive nutrients from the fluid circulation upon spinal joint movements. Joint misalignment in the spine hinders this action from occurring and causes thinning and degeneration of the discs. The Spine Relaxer table works by creating passive motion that causes mild stretching of the spinal joints and improves mobility. Intersegmental traction table functions by mobilizing the spinal column while at the same time gently stretching the muscles and ligaments. When the postural muscles of the spine or the muscles which help in keeping an individual in a straight position are disturbed or affected badly due to injury, fatigue, poor posture or accident, it causes spasms in them.
SAFETY
For the vast majority of prospective clients, it is a safe and beneficial treatment. However, there are specific conditions that are contraindicated for this treatment. They are listed below.
If you have a chronic disease or a recent surgery, it is recommended you consult your doctor.
It is important the abdomen musculature is relaxed during the session, therefore,
it is recommended not to eat 1 hour before and after the treatment session.
You should NOT use the Ceragem bed if you;
weigh 300 pounds or more.
are pregnant.
have had surgery in the past three months.
have a pacemaker, defibrillator, or other medical implant.
are under 12 years old
are shorter than 4’4″.
Do you agree to the Policy? Click the box below for "yes". *
Stretch/Massage Consent form
PLEASE READ and agree by booking an appointment online to the following and acknowledged before scheduling an appointment.
***Due to the Electronic health consent form, the name of the person who will receive the treatment must matched with the name that appear through the online scheduling and credit card on file (No exception please, including the spouse or any family member) unless the person is underage.***
1. The therapist and the clients will be wearing appropriate MASK the whole time before, during, and after the session.​
2. If the client show up with the body temperature is higher than 98.6 F the session will be treated as no show.
3. Clients need to wear an appropriate MASK in the clinic at all times. The massage therapist will be wearing MASK necessary suggested by the CDC and Health Department.
4. For the client's safety, for those who have traveled outside the country within 3 weeks, have any suspicious related symptoms and/or have pre-conditions and vulnerable to contracted the COVID-19
PLEASE "DO NOT" schedule any appointment at this time.
5. All sessions ( Deep tissue or Traditional Thai Massage) the client will be wearing comfortable loose fitting clothes and is the client responsibility to bring their own. No oil or lotion will be used. If the client show up with inadequate wear and violated draping ethic, the session will be treated as no show.
Our Thai massage stretch and massage therapy is an physical art form and might involve back walking, stretching, massaging which requires the close contact of client and therapist. Massage therapists adhere to strict professional guideline, any suggestion and/or sexual behavior committed by any party will NOT be tolerated. In the event of misconduct, the massage therapist reserves the right to terminate the session immediately, to charge full price for the service, and/or refuse service to the client thereafter.
We respect your privacy completely. Client shall be covered, draped, or clothed. If you feel uncomfortable at any time, for any reason, please inform us Immediately so that we may take direct action to remedy the situation or discontinue the service.
Contraindications for a Massage
Elevated body temperature, above 38 degrees Celsius
Considerable weakness (e.g. after an illness or a very intense effort)
Considerable inflammatory condition (e.g. of veins, joints, tendons, intestines, kidneys, meninx, etc.)
Contagious and viral diseases
Skin diseases (e.g. mycosis or psoriasis) and any purulent lesions
Fresh wounds or scars
Diseases of heart and cardiovascular system (e.g. diastolic blood pressure above 110, first two weeks after an infarction, advanced atherosclerosis, aneurysms, fresh hematoma, etc.)
First days of post-traumatic condition (e.g. twist, bruise, strained muscles or tendons)
Fractures and fresh adhesions (minimum 4 months of the injury): strict prohibition of massage of the fracture dressed with metal plates or screws
Gastrointestinal ulcers, coeliac disease, hernia, parasitic diseases
Tumors, whether malignant or not, and after removal of a tumor the place of the tumor and its area is not to be massaged – a matter to be agreed with a physician individually
Nervous system diseases (e.g. epilepsy, stroke, hemorrhage, sciatica, etc.)
Bone diseases (e.g. advanced osteoporosis)
Menstruation, particularly the first day or when it is particularly intense and painful
Pregnancy: the massage type may be adjusted to the stage of pregnancy, provided the attending physician consented thereto
Condition after consumption of alcohol or use of drugs
You agree by booking online for an appointment, to the policy and DO NOT have any of the contraindications.
I acknowledge that pain management treatments, the practice of and the practice of massage, including, but not limited to lymphatic Drainage, Compression Therapy, Infrared Sauna, Back Relaxer, Cupping, Graston, Steam Tent, Massage Therapy, Lymphatic Massage, Muscle Contouring and Thai Massage Stretch is not an exact science and no specific guaranties can or have been made concerning the outcome. I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required in order to realize a difference.
I also understand and agree to assume the following risks and hazards which may occur in connection with any particular treatment including but not limited to: unsatisfactory results (you must follow the aftercare instructions), soreness, change in skin pigmentation and allergic reaction ( please let us know if you' re allergic to anything I understand that even though precautions may be taken in my treatment, not all risks can be known in advance).
Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend, hold harmless and release from any and all liability Muscle Therapy Wellness Lounge and the individual that provided my treatment, the insured, and any additional insureds, as well as any officers, directors, or employees of the above companies for any condition or result, known or unknown, that may arise as a consequence of any treatment that I receive.
I have fully disclosed on my client intake form any medications, previous complications, or current conditions that may affect my treatment. I understand and agree that any legal action of any kind related to any treatment I receive will be limited to binding arbitration using a single arbitrator agreed to by both parties.
The client indicated below also agrees to forever hold harmless and release Muscle Therapy Wellness Lounge from any and all liability, claims, or demands of any kind or nature related to the transmission of any disease, condition or illness they may allege to have contracted or been exposed to as the result of any treatment, person, or visit at the insured's location.
Massage Packages:
Packages are non-negotiable, and non-transferable. All massage packages expire 1 year from date of purchase.
Prenatal Massage:
If I’m pregnant can I receive a massage or any treatments? Generally not recommended in the first trimester so please consult with your doctor prior to receiving any service. Please inform us when booking an appointment so that we can set you up with a practitioner who specializes in prenatal massage. Or if you’re booking your appointment online, please choose the prenatal massage option so that we can pair you with the appropriate massage practitioner.
Cancellation/Late policy:
All appointments cancelled with less than 24-hour notice will be charged in FULL. We hold appointments 15-minutes past scheduled time, unless you inform the Service Desk that you are on your way.
Massage Session:
Massage appointments are inclusive of consultation with your massage practitioner to personalize your visit. New clients will need to fill out a client intake form. Your appointment also includes time for transition before and after your service. Please inform your practitioner of any medical issues, recent injuries, or surgeries.
What to Wear
We recommend that you wear comfortable, flexible clothes and avoid wearing jewelry, makeup, perfumes or colognes whenever possible when at Muscle Therapy Wellness Lounge for a session.
You may choose to completely disrobe or remain partially clothed for your massage. We are happy to work through clothing if necessary. Please note that should you choose to completely disrobe, only the part of your body being massaged will ever be exposed.
Your therapist will leave the room to allow you to disrobe to your level of comfort in private. They will also step out at the end of the session to allow you to get dressed.
We do not have showers available at Muscle Therapy Wellness Lounge. However, a moist, warm towel can be made available for you upon request at the end of your session should you want to freshen up before dressing.
Some of our therapists who provide assisted stretching may request that you keep your undergarments on to ensure your comfort when moving you in and out of stretches for the legs and lower body.
Tip Policy:
Tipping is customary in the massage world but not mandatory and usually between 10-20% of the price of the massage. At Muscle Therapy Wellness Lounge you can either opt to tip the Therapist in cash directly or you have the option to add the tip to your Credit card at checkout.
Misconduct
Any verbal or physical conduct of a sexual or aggressive nature is inappropriate during the massage; your massage practitioner will end the session if this becomes a concern. Muscle Therapy Wellness Lounge reserves the right to limit, suspend, or terminate services in cases of, but not limited to, inappropriate or unhealthy behavior as deemed by Muscle Therapy Wellness Lounge management.
I have read and agree to the terms above * BY BOOKING AN APPOINTMENT AND PAYING FOR IT.