Genie Hands, LLC

Medical Intake & Consent Policies Form

This form covers Medical Intake and required Consent & Policies. Please complete it accurately so we can confirm your session is appropriate and safe.

All sections are open below—scroll through and complete each one.

Section 1 — Identify your appointment So we can match this to your request

Important Information

Please use the same name and email you used on the appointment intake form.

Full name *

Email *

Phone number (optional)

Intake session ID (from your link)

This field is filled when you open the form from your email link (?intake_session_id=… or ?session_id=…). It cannot be edited on this page. The same link may include full_name, email, and phone.

Section 2 — Medical intake Safety & suitability

Important Information

Please answer accurately and completely. This information is for your safety and to confirm services are appropriate. Policies are in Section 3 and the full Terms & Conditions.

Have you had or are you scheduled for a medical procedure?

Yes No

Procedure type *

Common procedures where lymphatic massage & post-op bodywork may apply. Not a complete list of all surgeries.

Procedure details (optional)

Date of procedure *

Use the scheduled or actual procedure date.

Days post-surgery (auto-calculated)

Calculated from today’s date minus your procedure date. A negative number means the procedure is still upcoming.

Are you currently under medical care? *

Yes No

Have you been cleared by a physician to receive massage or bodywork? *

Yes No

Current medications & supplements *

Relevant medical conditions *

Section 3 — Consent & policies Acknowledgments required to book

Liability Waiver & Client Consent

By proceeding, you acknowledge and agree that all services provided by Genie Hands LLC are for wellness, relaxation, and post-recovery support only and are not medical treatment.

You have disclosed all medical conditions and relevant health information
You understand there are risks including soreness, bruising, swelling, or discomfort
You accept full responsibility for your body and recovery process
You release Genie Hands LLC from any liability related to services provided
You understand results are not guaranteed

We may refuse or terminate service for safety, undisclosed conditions, or inappropriate conduct (including harassment or threats), with no refund in those cases. Serious misconduct may result in forfeiture of payments and permanent refusal of service.

To the fullest extent permitted by Florida law, Genie Hands LLC is not liable for injury, complications, damages, or losses from services except gross negligence or willful misconduct. You agree to indemnify the Company for claims arising from nondisclosure, your negligence, misuse of services, or violation of these Terms.

These summaries do not replace the full Terms & Conditions.

* I have read and agree to the Liability Waiver and Terms & Conditions, and I understand services are provided at my own risk.

* I understand my appointment is not confirmed until the deposit is received, valid photo ID is submitted, and written confirmation is sent.

* I understand a $100 non-refundable deposit is required to secure my appointment.

Cancellation, rescheduling & no-shows — confirm each *

Changes require at least 24 hours’ notice Changes within 24 hours may incur a $40 fee Same-day cancellations are non-refundable; no-shows forfeit the deposit

View full Terms & Conditions (opens in a window)