new client consent form | BRAVO Manual Therapy

client consent form

First Name

Last Name

Address

Phone

Who referred you to Bravo MT?

* BRAVO Manual Therapy is a referral-only service. You must provide the name of at least one current client in good standing with BRAVO MT to submit your appointment request or reservation.

I wish to receive appointment confirmation texts (confirmations are a courtesy + are not guaranteed. Not receiving a confirmation text does not negate our cancellation policy).

Cancellation Policy

I wish to subscribe to Bravo Manual Therapy's email list to recieve important news, updates and occasional blog posts.

By checking this box, I understand that all manual therapy provided by Becka Bravo, LMT (or qualified therapist acting in her stead) is for the purpose of one or more of the following: stress reduction, pain reduction, relief from muscle tension, increasing circulation, or other specific reasons previously discussed. 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 understand that massage therapy is not a substitute for medical care and that it is recommended that I work with my primary caregiver for any condition I may have. I have stated all my known physical conditions and medications, and I will keep the massage therapist updated on any changes. I understand and agree to BRAVO Manual Therapy's cancellation and payment policies . View terms of use

Briefly describe any current primary complaint you may have:

What are your primary goals in working together?

If other, please explain:

BOOK NOW.

BECKA BRAVO, LMT / 500 CYT
private clinical massage + functional yoga

773.410.6578

client consent form

R E S O U R C E S .

When paying cash, exact change is required. Therapists do NOT carry cash on their person.