As a Client of Whole Body Kinetics and Structural Wellness, we request that you are informed about our Policies to provide informed consent prior to the session.
Whole Body Kinetics and Structural Wellness, LLC reserves the right to refuse any client, for any reason, at any time.
All sales are final. This includes all product and service purchases, including promotional packages and memberships.
Appointment times have been arranged specifically for you. Our time is valuable and so is yours, if you are late for your scheduled appointment, you forfeit that time. Client no shows for appointment times will result in the full fee for the service at the 3rd missed appointment unless evidence is provided that demonstrates illness, emergency or poor weather conditions. In turn, we promise to honor the scheduled appointment time. Please cancel or reschedule appointments at least 24 hours in advance.
The intake provides time for the therapist to discuss each section of the policies contained on this website. Prior to each session, the treatment plan will be discussed with you. At your first session you will receive an electronic copy via email of Whole Body Kinetics and Structural Wellness, LLC’s Policies and Procedures and will be asked to sign the consent stating that you have read the information, understand it, and agree to comply with Whole Body Kinetics and Structural Wellness, LLC’s Policies and Procedures.
Informed Consent / Waiver of Liability / Assumption of Risk
1.) I fully understand the purpose of Structural Integration 10 Series is to balance and align the physical body so that it is supported and maintained by gravity in three dimensional space. This is done through direct manipulation and education so that greater ease of movement and improved posture is achieved in order to assist me in establishing balance and alignment in my body. I understand that Rolfing Structural Integration is not involved with the treatment of disease of any kind, nor does it substitute for medical diagnosis or treatment when such attention is needed. The Practitioner does not treat, prescribe or diagnose any illness, disease, or any other physical or mental disorder of the person. Nothing said or done by the practitioner should be misconstrued to be such. I understand that Rolfing Structural Integration, Craniosacral Therapy, Medical Massage, Movement Integration or other forms of Bodywork are processes and are not effective as a “quick Fix” for chronic complaints. This process is interactive and requires practice and awareness from the client. I understand that this work is most effective if the assigned “homework” and or participation in Pilates exercises are participated in.
2.) In understand and expressly assume all risks of my participation in the programs of movement re-education, strength, flexibility, pilates and other exercise training and conditioning by Whole Body Kinetics LLC, and I hereby waive, release and forever discharge any and all claims or causes of action which I might otherwise bring against Whole Body Kinetics LLC, its officers, employees, trainees, and contractors with regard to injuries, damages, or losses arising from or relating to my participation in the above-mentioned activities or the use of equipment, props, apparatus, or machinery in these activities.
3.) I understand and am aware that movement re-education, strength, flexibility, Pilates and other exercise training and conditioning, including the use of fitness equipment of any kind, are potentially hazardous activities. I also understand that these activities involve the risk of injury and possibly even death, especially to people with preexisting injuries, illnesses or medical disabilities. These risks include, but not limited to: mild light headedness, fainting, abnormalities of blood pressure or heart rate, ineffective heart function and in rare instances, heart attack or stroke. The reaction of the cardiovascular system to such activity cannot be predicted with complete accuracy. I am voluntarily participating in these activities and using Pilates and other equipment and machinery with knowledge of the dangers involved, and with the understanding that certain, inherent risks cannot be eliminated regardless of the care taken to avoid injuries. I hereby agree to expressly assume and accept any and all risks of injury or death.
4.) I hereby declare myself to be of sound mind and physically suffering for no condition, impairment, disease, infirmity or other illness that could prevent my participation in movement re-education, strength, flexibility, Pilates and other exercise training and conditioning or in the use of Pilates and other fitness equipment and machinery. I also understand that a medical evaluation is advisable before participation in above-mentioned activities. I acknowledge that I have either had a physical examination and have been given my physician's permission to participate, or that I have decided to participate in activity and use of Pilates and other fitness equipment and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of Pilates na d other equipment, apparatus and machinery.
5.) I understand it is my responsibility to fully inform, and keep fully informed, the Whole Body Kinetics instructors and staff working with me of any physical condition or disability which would prevent or limit my participation in an exercise physical conditioning program. I further acknowledge that, while the program may have substantial physical benefits, Whole Body Kinetics practitioners do not engage in diagnosing or treating medical disease or deficiencies.
6.) I authorize Whole Body Kinetics to use photos and or other likenesses of myself for any promotional materials regarding Whole Body Kinetics. Such photos and other likenesses will not be shared or sold to other parties. Promotional materials bearing these likenesses may be distributed for fee to the public and posted on the Whole Body Kinetics website. Whole Body Kinetics reserves the right to use photos or likeness for the time period beginning when this form is singed and ending upon written request of the participant.
Package Expiration Policy
I understand that prepaid packages for classes or private / small group sessions, Rolfing Structural Integration, Bodywork or Therapeutic Massage services must be used within six months from the date of purchase. Sessions remaining on a package and not used by the end of that six month period will be lost.
Certain monthly memberships or packages expire at the end of each month and are automatically renewed at the beginning of the next month. Monthly packages and memberships are billed a full month in advance and require one month notice prior to termination to avoid fees. For example, the payment for February is due in January. To avoid being charged for February you must notify Whole Body Kinetics at the time of payment in January. Refund or transfer requests submitted in writing prior to expiration will be honored, minus any credit card fees (if applicable) assessed for processing the return.
At Whole Body Kinetics and Structural Wellness, LLC sessions are by appointment only. To ensure appointment availability, it is suggested a regular series of appointments be scheduled and packages are available.
A credit card may be required when scheduling. The card is not charged at time of scheduling. Credit card information is used in cases of enforcing the Whole Body Kinetics and Structural Wellness’ Cancellation, No-show or Late policy. When scheduling an appointment with Whole Body Kinetics and Structural Wellness, LLC, the client understands, acknowledges and authorizes their credit card to be charged appropriate fees based on the Whole Body Kinetics and Structural Wellness, LLC Cancellation, No-Show and Late policies.
I understand that all Whole Body Kinetics Studios reserved appointments (evaluations, classes, private, semi-private, Rolfing Structural Integration, etc.) are subject to a 24-hour cancellation policy. This policy is in place for the benefit of all clients and instructors, allowing clients to take a class or private session opening when they become available, and instructors to offer open spots to appointment-seeking clients in a timely fashion.
I herby acknowledge that failure to cancel any scheduled appointment with Whole Body Kinetics prior to the 24-hour window (not including medical emergencies or poor weather) will result in my being automatically charged for the missed class or appointment at a rate of 50% for a cancellation within 12-24 hours and 100% for a charged inside of 12 hours, with the exception of one late cancel per calendar year which is granted for all clients in good standing. I further acknowledge that failure to cancel a class or appointment reservation outside of 24 hours will also be charged at the full rate if client fails to show.
I acknowledge that all cancellations can be done via phone, text message (773 963-2358) or Email (email@example.com), and appointment cancellations will automatically generate notification to my instructor. If I am NOT cancelling online, I will notify my instructor directly as soon as possible and no later than 24 hours in advance.
Anyone who either forgets or consciously chooses to forgo their appointment for any reason will be considered a “no-show”. They will be charged for their “missed” appointment in full. Service will be denied until payment is made.
Clients who have purchased a package will not be charged a fee, but a session is forfeited. Gift certificate/ voucher/ or coupon will be forfeited and a $25 fee may be charged to card on file for no show appointments.
Late Arrival to Scheduled Appointment
Appointments begin and end on time. If you arrive late, your session will be shorter to allow the session of the clients start on time. Depending upon how late you arrive, your therapist will then determine if there is enough time remaining to start a treatment. Regardless of the length of the treatment actually given, you will be responsible to pay the session in full. Scheduled sessions will be cancelled after 20 minutes have passed the scheduled appointment time. The session fee will be charged to the card on file. Gift certificate/ voucher/ or coupon will be forfeited and a $15 fee will be charged to card on file for no show appointments.
Whole Body Kinetics and Structural Wellness, LLC Studio recognizes that both Therapist and Clients are vulnerable to infections and therefore ask clients to cancel appointments when they are feeling unwell.
If you have any of the following contagious illnesses, your session will be rescheduled: Diarrhea, Vomiting, Fever, Chicken pox, Measles, Mumps, Meningitis, Hepatitis A, Conjunctivitis, Rubella, Head Lice, Body Lice, Impetigo, Influenza (Flu), Meningococcal Disease, Polio, Ringworm of the body, feet or scalp, Scabies, Thrush, Whooping Cough and the Common Cold, Pneumonia, Bronchitis.
Scope of Practice
Certified Rolfers® are allied health care professionals who are trained in the use of manual techniques to normalize the soft tissue of the body. Therapeutic Bodywork and Pilates are intended to be a health-enhancing system that promotes body balance and efficient body function. Bodywork and Pilates stimulate the natural restorative processes of the body and mechanically reduces muscle tension. These methods may not be used to diagnose or treat any specific, preexisting condition without written permission from your physician. If any situation that may arise during the session and if the therapist feels you should be evaluated by another professional - It is our intent at Whole Body Kinetics & Structural Wellness, LLC under the bodywork therapy policies, to refer you to your personal health care physician. Therapist does not diagnosis or prescribe for any dysfunctions of the body. The therapist is required to refer you for diagnosis and to follow recommendations of your physician. The therapist is a skilled practitioner of safe, structured touch that is beneficial for many life hurts, aches, and pains. Rolfing® Structural Integration and Pilates are a maintenance system, and the benefits are cumulative. It is best to receive a 60-minute session every week to reduce the physical stress that builds in the body. Appointments scheduled every other week, combined with gentle stretching and other self-help methods, are also sufficient. Monthly appointments are beneficial for those who are effectively dealing with stress management. Occasional appointments provide temporary symptomatic relief, but the cumulative effects of therapeutic Bodywork are lost if massage therapy is not used on a regular basis.
Pilates Method Alliance www.pilatesmethodalliance.org (04/01/2015) Scope of Practice PMA® Scope of Practice PMA® Members & PMA® Certified Pilates Teachers must work within the scope of practice of a Pilates teacher as outlined below:
The following is within the scope of practice of a Pilates teacher
1. Design Pilates exercise programs according to an individual’s needs.
2. Recognize conditions that would preclude a client from safely participating in a Pilates exercise program.
3. Coach, provide general information, and direct clients to seek medical attention as necessary.
4. Receive exercise guidelines and clearance from medical practitioners, when appropriate, to ensure client safety.
5. Document client progress and cooperate with referring medical practitioners.
6. Promote exercise to improve overall health.
7. Request permission to touch clients and observe practice laws within your jurisdiction.
8. Use appropriate touch to facilitate movement, position the client, and prevent injury or damage.
The following is beyond the scope of practice of a Pilates teacher
1. “Prescribing” an exercise program.
2. “Diagnosing” a client with any medical, mental or physical condition.
3. Continuing to train a client with a condition that is beyond your knowledge without appropriate medical clearance.
4. “Prescribing” diets or recommending supplements.
5. Claiming to “treat” or “rehabilitate” injury or disease.
6. Monitoring (measuring with instrumentation) the progress of clients referred by therapists or medical practitioners.
7. Offering counseling.
8. Claiming to be competent to offer professional education beyond the limits of your credentials.
9. Applying inappropriate touch.
10. Continuing to train a client who exhibits any of the following unusual symptoms: e.g. chest pain, prolonged dizziness, rapid heart rate, shortness of breath, significant decrease in coordination, loss of consciousness, faintness, nausea, blurred vision, prolonged or increasing pain.
Client / Professional Boundaries
In this partnership, it is important that the client is honest and open with the therapist. Feedback of pressure, clothing, comfort, discomfort, massage techniques, positioning, temperature, privacy, etc. is very important prior to, throughout and after the session. Please share this information with the therapist, as you become aware of it. Sometimes it is hard to remember where you are sensitive until the area is touched. If we do anything to make you feel uncomfortable, tell us immediately. We hold our practice to a very high standard.
Clients who receive Rolfing® Structural Integration remain clothed (shorts, sports bra, tank-top, exercise pants) and no draping is required. Please arrive in appropriate clothing at the time of your appointment. For questions please call, text (773 963-2358) or email (firstname.lastname@example.org).
Sexual Interaction, Behavior and/or Discussion
Sexual interaction or discussion of any kind between the client and the therapist is never appropriate and is illegal.
Requests, comments or behaviors of a sexual nature will not be tolerated and will be viewed as solicitation. The session will be terminated and reported to the proper authorities under the guidelines of Whole Body Kinetics’ therapy policies and procedures. The client will not be rescheduled. There is no exception to this policy.
Hygiene & Sanitation
All equipment and linens that come in contact with the client are cleansed in an approved method. All lubricants are dispensed in a contamination-free manner. The therapist's hand and forearms are washed with hot soapy water and disinfecting solution, before and after each session.
We request every client to arrive with acceptable hygiene and clean for a session. The client will inform the therapist of breaks/cuts in the skin and these areas will be avoided. We request that clients shower if they exercised prior a session.
Children and / or Guest During Sessions
Guests may be present during the session at your request. The guest must remain quiet and seated during the session. Guests may not interfere with the therapist's work for any reason. Children are prohibited during sessions in the therapy room. Children may not be in the waiting room if unattended. Children are always required to be quiet and seated while in the waiting area. Occasionally, we must lock the main door of the office (the therapy room is never locked). If a client has someone waiting during their session, the client's guest will be required to stay inside the building or return after the session has completed.
Confidentiality and Conversation
Any discussion between the therapist and the client is confidential. The client may or may not choose to talk during the session. We are happy to listen to your conversation and share professional expertise. It is preferred to not discuss topics of a sexual or political nature. We may be required to release records under court order, or to your doctor.
We are obligated to report suspicion of abuse or child abuse to the proper authorities.
Existing & New Medical Conditions
It is the responsibility of the client to keep the therapist informed of any medical treatment currently being taken, and to provide written communication from a physician, chiropractor, physical therapist, etc., that Bodywork therapy and or Pilates may be continued. The client must keep the therapist informed of any changes in their health condition. The therapist will always ask at least twice before every session of current medical conditions, medications, allergies the client is aware of. Whole Body Kinetics and Structural Wellness, LLC does provide Bodywork to individuals currently being treated and / or for a past cancer diagnosis. For those reasons, we also will always ask (verbally & otherwise) twice prior to your session, if you are currently being treated or ever have been treated for a cancer diagnosis. The therapist will ask every female client, regardless of age, if they are currently pregnant, prior to the session.