:: INFOrMATION ::
SIT BACK, RELAX, AND PERUSE
THE FINE PRINT
Respect...it is one of our core values.
It's important to us that we share all the finer details with our clients upfront. Upon booking appointments with us, these are all the consent, waivers and agreements made between each other.
If you have any questions, please contact us.
1. TERMS + CONDITIONS
Thank you for choosing Body + Breath as your massage and bodywork provider. In order for us to provide the best service to our clients, please review the following terms + conditions:
CONSENT + MEDICAL CARE
It is my informed and voluntary choice to receive massage therapy. I give my consent for massage and am aware of the benefits and risks (including potential short-term muscle soreness, superficial bruising and exacerbation of undiscovered injury). I therefore release my massage therapist and Body + Breath, LLC from all liability concerning these risks that may occur during a massage session.
I understand that I may withdraw my consent at any time.
I understand massage is not a substitute for medical care. That the massage service offered is for the purpose of general wellness, stress reduction, and relief of muscular tension. I understand that massage therapists do not diagnose illness or disease, and nothing said during the massage should be construed as such.
I understand that my personal health information will be collected, and that all information will be kept confidential unless required by law. I consent that my medical information may be shared by various care providers involved in my care and treatment.
INFORMING MY MASSAGE THERAPIST
I have stated all medical conditions that I am aware of and do not have any injuries or conditions that prevent me from receiving massage therapy. I understand the importance of continuously informing my massage therapist of all changes to my medical conditions and medications, and that there may be additional risks based on my physical condition.
If I experience any pain or discomfort during the session, I will immediately inform my therapist so the pressure or techniques used can be adjusted to my comfort level. I will not hold my massage therapist responsible for any pain or discomfort I experience during or after the session.
CONTAGIOUS CONDITIONS
I currently have no symptoms of coronavirus, I have not received a positive test for coronavirus within the past 14 days, nor have I knowingly spent time with someone recently who has tested positive.
I do not have any contagious conditions that may put my massage therapist or other clients at risk.
LATE ARRIVAL
All scheduled appointments will end at the scheduled ending time in order for my massage therapist to stay on schedule. Clients who arrive late for their appointment will be charged the full session price and will not receive a time extension.
CANCELLATION + NO SHOW
I understand Body + Breath greatly appreciates and requires a 24 hours notice to cancel or reschedule an appointment. Clients who cancel/reschedule an appointment within 24 hours of the scheduled appointment time will be charged 100% of the service price with their credit card on file, the gift certificate they are using or by mailed invoice. There are no exceptions to this policy.
For new clients, payment is required at the time of booking. Refunds will not be provided for no shows or cancelling/rescheduling less than 24 hours before appointment start time.
I understand no shows are charged in full for the missed service and that not informing the therapist of missing the appointment is grounds for immediate termination of any future appointments.
TERMINATION
I understand that I or my massage therapist may terminate the session at any time. Immediate termination will occur in the event of inappropriate conduct of any kind. This includes harassment, threatening speech or behavior, sexual advances or requests, or disrespectful actions or language.
A session will not be conducted if the client is under the influence of drugs or alcohol.
If the massage is terminated for any of these reasons, full payment for the scheduled session is still required.
EMAIL MARKETING
I consent to receiving email marketing regarding studio updates and news. I understand I can unsubscribe at any time.
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I have been given the opportunity to ask questions about massage therapy and my questions have been answered.
2. Credit Card Information Storage Consent Form
PURPOSE OF INFORMATION COLLECTION + STORAGE
I, the undersigned, understand that Body + Breath, LLC (hereafter referred to as "the Provider") collects and stores my credit card information for the purposes of processing payments for services rendered, including massage therapy sessions, products, and any applicable fees. By signing this consent form, I agree to the following:
CREDIT CARD INFORMATION STORAGE
I authorize the Provider to securely store my credit card information on file for future transactions related to services or products provided by the Provider. This information may be used for payment processing, including recurring payments if applicable.
SECURITY OF INFORMATION
The Provider agrees to take appropriate measures to securely store my credit card information and to comply with relevant data protection laws and industry standards (including, but not limited to, the Payment Card Industry Data Security Standard, PCI DSS). My credit card information will not be shared with third parties except as required by law or as necessary to process payments.
RIGHT TO UPDATE OR REMOVE CREDIT CARD INFORMATION
I understand that I have the right to update, modify, or request the removal of my stored credit card information at any time by providing written notice to the Provider. I may also request that my payment information be removed from the Provider's records.
TRANSACTION AUTHORIZATION
I authorize the Provider to charge my credit card for any services or products I request, as well as any additional charges for missed appointments, cancellations (if applicable), session terminations or fees agreed upon in advance. I understand that I will receive notification of the charges through receipts or email.
CANCELLATION OF STORED INFORMATION
I understand that I can revoke my consent to store my credit card information at any time, and request removal of my stored information. If I revoke consent, I understand that I may need to provide alternative payment methods for future services.
TERM OF AGREEMENT
This consent remains in effect until I notify the Provider in writing of my intent to revoke it.
By signing this form, I acknowledge that I have read and understood the contents of this consent/waiver form and voluntarily agree to the terms outlined above.
(This form was generated by AI)
3. Vermont Data Privacy Act Consent
EFFECTIVE DATE :: 07.18.23
At Body + Breath LLC, we are committed to respecting and protecting your privacy. In compliance with the Vermont Data Privacy Act (VDPA), this form outlines how we collect, use, and manage your personal data. By signing this form, you are acknowledging that you understand how your information will be handled.
PERSONAL DATA COLLECTION + USE
We collect and use your personal data for the following purposes ::
To provide and personalize massage therapy services
To process your payments and manage appointments
To maintain accurate medical and health records (as required for treatment)
To communicate with you about your appointments, treatment plans, or any updates regarding our services and studio
TYPES OF PERSONAL DATA COLLECTED
Personal Identification Information :: Name, phone number, email address, etc.
Health Information :: Medical history, conditions relevant to treatment (e.g., injuries, chronic
conditions, allergies)
Payment Information :: Credit card details or other payment methods for service fees
YOUR RIGHTS UNDER THE VERMONT DATA PRIVACY ACT
As a resident of Vermont, you have certain rights regarding your personal data. These include ::
Access to Data ::You have the right to request access to the personal data we have collected about you.
Correction of Data :: You have the right to request corrections to any inaccurate or incomplete personal data.
Data Deletion :: You have the right to request the deletion of your personal data, subject to certain legal limitations.
Data Portability :: You have the right to request a copy of your personal data in a structured, commonly used format, and to transmit it to another service provider if desired.
Opt-Out of Marketing :: You have the right to opt out of receiving marketing communications from us at any time.
:: To exercise any of the above rights, please contact us at ::
Body + Breath LLC
160 Wall Street, Springfield VT 05156
802.300.3311
emily@bodyandbreathvt.com
SHARING OF PERSONAL DATA
We do not share, sell, or rent your personal data to third parties for marketing purposes. However, we may share your information with service providers who assist with business operations, such as payment processors or appointment scheduling platforms. These third-party service providers are contractually obligated to safeguard your data and only use it for the specific purposes for which it was shared.
We may also share your information as required by law or to protect the safety, rights, or property of Body + Breath LLC, our clients, or others.
DATA RETENTION
We retain your personal data for as long as necessary to fulfill the purposes for which it was collected, including complying with legal obligations, resolving disputes, and enforcing our agreements.
(This form was generated by AI)
4. pediatric
(minor) consent
*Clients under the age of 18 must have this form completed by their parent or legal guardian.
AS THE PARENT OR GUARDIAN, I UNDERSTAND AND CONSENT TO THE FOLLOWING:
Massage services offered at this practice are for the purpose of general wellness, stress reduction, and relief of muscular tension.
I (parent or guardian) must remain at the treatment office for the duration of the minor’s massage session. I may remain in the treatment room throughout the session. I (parent or guardian), the client, or the massage therapist have the right to terminate the session at any time.
The client does not have any injuries or conditions that prevent receiving massage therapy. I understand the importance of informing the massage therapist of all medical conditions and medications that the client is taking, and that there may be additional risks based on the client’s physical or mental conditions.
I have been given the opportunity to ask questions about massage therapy and my questions have been answered. I have been advised of the policies and procedures pertaining to massage and I understand these policies and procedures.
If my child experiences any pain or discomfort during this session, my child will immediately need to inform the therapist so the pressure and/or techniques may be adjusted to their level of comfort. I further understand that massage/bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that my child should see a physician or other qualified medical specialist for any mental or physical condition of which I am aware. I agree to keep the therapist updated as to any changes in my child’s medical profile and understand that there shall be no liability on the massage therapist’s part should I fail to do so.
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By signing below, you acknowledge that you are the parent or legal guardian of the minor who is to receive massage treatment at Body + Breath. You acknowledge that you have read and understand all information on this form, and authorize this massage practice to provide therapeutic massage for your child or dependent.
5. cupping informed consent
WHAT IS CUPPING MASSAGE?
Cupping Massage is a treatment that creates negative pressure (vacuum/suction) within a silicone cup atop the skin.
CUPPING BENEFITS
Relieve muscle tension and pain
Loosen scar tissue and adhesions
Increase range of motion
Improve blood and lymphatic flow and circulation
Assist in detoxification
Reduce inflammation
Promote relaxation
Enhance the body’s natural healing processes
TREATMENT DESCRIPTION
Cups are placed on the skin, usually along muscles or energy pathways (meridians).
While gently pulling up on the cup, other techniques include gliding, shaking, popping, and rotating.
The suction may cause localized redness, marking (skin discoloration), or a feeling of tightness or pulling in the areas where the cups are placed.
The cups are generally left on for 5–15 minutes, though this duration may vary based on individual needs and treatment goals.
The practitioner may also combine cupping with manual massage, stretching, or other therapeutic techniques.
RISKS + SIDE EFFECTS
Potential reactions to Cupping Massage are temporary and may include:
Marking: Discoloration due to metabolic waste, toxins and other stagnant material that have been freed from underlying tissue. These marks may last anywhere from a few hours to several days.
Skin Irritation: Due to increasing blood flow and pulling stagnant materials to the surface of skin, mild redness, irritation and/or itching may occur.
Tenderness: Some individuals may feel discomfort or soreness after the procedure. (If tenderness persists for longer then 3 days, please inform your massage therapist.)
Dizziness / Lightheadedness: Some clients may feel lightheaded during or after the session, though this is typically brief.
Infection: Although rare, there is a risk of infection if proper hygiene procedures are not followed.
Post-treatment, some clients also experience detoxification symptoms (low energy, nausea, headache, an overall sense of not feeling well). Following proper post-treatment care helps minimize this side effect.
POST-TREATMENT CARE
Drink plenty of water to help eliminate toxins from the body
Avoid extreme temperature changes for 24 hours (ie avoid hot showers, steams, sauna, exercise for 3-4 hours, and ice)
Light stretching and range of motion exercises are beneficial
Rest
CONTRAINDICATIONS
Cupping therapy may not be appropriate for individuals with the following conditions:
Pregnancy (especially over the abdomen or lower back)
Blood disorders (e.g., hemophilia, clotting disorders)
Active cancer or tumors
Open wounds or skin infections at the site of cupping
Severe varicose veins or skin conditions (e.g., eczema, psoriasis)
Heart disease or uncontrolled hypertension
Recent surgery or injuries (unless advised by a healthcare provider)
Severe allergies to materials used in the cups (e.g., latex)
Blood thinning medication use
If I choose to experience this therapy in my treatment, I understand the benefits, side effect and after-care recommendations. I agree to inform my massage therapist of any discomfort experienced during the session. I have stated all relevant physical conditions and agree to keep my massage therapist updated to any changes in my health or medications. I understand massage therapy and Cupping Massage are not substitutes to medical care.
