Exercise & Massage Therapy
Please take a moment to carefully read the following information, sign and submit.
I understand that the exercise and posture/alignment therapy I receive is provided for the purpose of posture and alignment correction, muscular imbalance correction, corrective exercise instruction and guidance, restoration of normal musculoskeletal function, reduction of pain caused by diseases, injuries or postural dysfunctions.
I further understand that exercise and posture therapists, manual therapists, personal trainers and wellness coaches are not qualified to diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session(s) given should be considered as such. I should see a physician, or other qualified medical specialist for any mental or physical ailment that I am aware of.
I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the exercise therapist and personal trainer updated as to any changes in my medical profile and understand that there shall not be liability on the therapist’s part should I forget to do so.
I understand that I have enrolled in the personalized health and exercise program offered through Certified Personal Trainer, Certified Exercise and Posture/Alignment Therapist and Certified Massage and Manual Therapist, Nesve Yayalar and her company, Great Anatomy, Inc. I recognize that the program may involve physical activity including, but not limited to, muscle strength and stretching exercises, and other various exercise activities.
I also agree that the program may consist of therapeutic exercises, mobilization, massage and manual therapy, muscle testing, exercises and physical agents to aid in achieving my maximum potential for recovery within my capabilities. I agree to cooperate fully, to participate in all physical exercises, and to comply with the plan of care as it is established.
I acknowledge that my enrollment and subsequent participation in purely voluntary and in no way mandated by Nesve Yayalar. In consideration of my participation in this program, I hereby release Nesve Yayalar and her company, Great Anatomy, Inc. from any claims, demands, and causes of action as a result of my voluntary participation and enrollment of the provided exercise and posture therapy sessions.
I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I hereby release Nesve Yayalar and her company Great Anatomy, Inc. from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, allergic reactions or any other illness or soreness that I may incur, including death.
I am purchasing the services of Great Anatomy, Inc. to design an exercise program to correct my posture and alignment, muscular imbalances, and aid in my discomfort and pain, improve my muscle strength, flexibility and mobility, alleviate my pain and discomfort and to enhance my wellness and health goals. I will not hold Nesve Yayalar and her company, Great Anatomy, Inc. personally liable for any problems, illnesses or injuries that might occur due to a sudden change in my eating or exercise habits. This program does not replace the advice of a medical doctor, or other medical provider or treatment. I have revealed any and all necessary information about myself to prevent any possible complications to Nesve Yayalar and her company Great Anatomy, INC.
Cancellation Policy: I understand that unpredictable situations can arise, but I do require 24 hour notice to cancel appointments. If notice is not given, you will be charged for the session. The amount of the fee will be equal to 100 % of the appointment fee. Individual circumstances will play a role in the therapist’s decision to charge cancellation fee. If you are more than 15 min late for your appointment, I may not be able to accommodate you. In this case, the same cancellation fee will apply. I will do my very best to reschedule your appointment for another time that is convenient to you.
You have read and voluntarily signed the waiver and release and further agree that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.
Thanks for submitting!
I understand that the massage and manual therapy given to me by CAMTC and NCBTMB certified massage therapist, certified medical massage therapist Nesve Yayalar, owner of Great Anatomy, Inc, Massage Therapy is for the purpose of (manual therapy, stress reduction, pain reduction, injury rehabilitation, relief from muscle tension and any present soft tissue restriction, breakdown adhesion or scar tissue, increasing circulation, or specific reasons stated here).
I understand that the 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 my massage therapist updated on any changes.
My goal is to provide you with a professional and fully customized clinical massage and manual therapy. I encourage you to familiarize yourself with the terms and conditions to avoid disappointment or confusion. If you have any questions or concerns, please feel free to contact me.
1. Appointments and bookings Appointments can be made via email, phone or text messages. The initial appointment includes the discussion of your health history and physical assessment, and it takes approximately 100 min; this ensures a 90 minutes massage treatment without time taken completing forms and healthy history. Your appointment arrival time will be agreed to when you book. It would be appreciated if you arrive no more than 5 minutes early to ensure my previous client has time to leave and I clean and set up for you, or if you are early, please have a seat on the patio.
2. Prices: Everyone will be charged the price shown on the website. No exception. Treatments must be paid for in full following completion of your treatment. You receive your invoice via email and you can pay online with a credit card. I also accept payments by Cash and personal Checks. For frequent treatments, 30 min session is $60, 60 min session is $80, 90 min session is $95 at my location. *Frequent treatment means if you schedule appointments at least once/month. For one timed appointments (or there is more than 30 days between appointments), 60 min session is $85 and 90 min session is $120. The initial appointment for treatments is $120. It includes discussion of your health history and physical assessment. It takes approximately 100 minutes. This is recommended if you have chronic pain and injuries.
3. Cancellation or reschedule No-shows and last minute cancellations are difficult for my business and it may mean other clients miss out. If you need to cancel or re-arrange your appointment for any reason, I require at least 24 hours notice. You may cancel by email, call or text. Appointments cancelled with less than 24 hours notice or failure to attend an appointment without notice may result in the treatment being charged in full.
4. Inappropriate Conduct: Under no circumstances will sexual comments or advances, or aggressive comments, or gestures be tolerated. Anything of this nature will result in termination of the appointment, with full payment expected. ALL incidents will be reported to the Police.
5. Health and hygiene practices: Health and hygiene is taken seriously and evaluated regularly at my practice. My therapy room is a clean and sanitary environment where your health and your therapist is a primary concern. All towels and linens are thoroughly washed in hot water before they are ready for the next client. The floors, surfaces and door handles are cleaned daily. Massage oils and lotions are dispensed from a pump bottle and spray bottle. Please read below COVID-19 health and safety measures.
6. Gift Certificates are non refundable and cannot be exchanged for cash under any circumstances. Gift certificates are subject to the cancellation or reschedule policy. If you would like to purchase a gift certificate, please email, call or text me.
7. Your data protection: During the initial consultation you will be asked to provide some personal details including name, address, date of birth and some medical information to ensure that any treatments I provide are safe and appropriate for you. These details are only recorded in paper form and are retained in a lockable file cabinet and room to which only I have access. They will never be shared with any 3rd party. I will use your contact information to contact you directly regarding your treatment. I do not use your data for marketing purposes and will never pass your information to 3rd parties.
8. Mobile Phones and devices must be switched off during the treatment.