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Intake Form

Request A Client Intake Form


Use the Contact section of the website to request a link to the Client Intake Form. Please include your name, email address, and mobile number.

To the Clients of Reflexology


You need to know that:


1.   A Reflexologist is not a doctor.

2.   A Reflexologist does not practice medicine.

3.   A Reflexologist does not diagnose or treat for a specific illness.

4.   A Reflexologist does not prescribe or adjust medication.

5.   Reflexology is not a substitute for medical treatment, rather it is a complementary modality to most types of therapy.

6.   Reflexology is intended to encourage the body to heal itself.

7.   Reflexology is a clothed modality. Only the shoes and socks are removed for a session.

8.   All client information is confidential, and that the reflexologist conducting your session, is bound to such confidentiality in accordance with the ARCB (American Reflexology Certification Board) Code of Ethics, and Professional Standards.


Studies show that:


1.  Reflexology promotes balance and normalization of the body naturally.

2.  Reflexology reduces stress and brings about relaxation.

3.  Reflexology stimulates circulation and the delivery of oxygen and nutrients to the cells.

I understand that:

A reflexology session should not be construed as a substitute for medical treatment,

and that I should see a physician, chiropractor or other qualified medical specialist for any mental or

physical ailment. I fully understand that the reflexologist conducting this session is not an allopathic

doctor, psychologist, or psychiatrist and does not portray himself/herself to be. I agree to keep the reflexologist updated as to any changes in my medical profile prior to any future sessions and understand

that there shall be no liability on the reflexologist’s part, should I fail to do so.


All client information is confidential.

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