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Molly Robinson Healing

Session Prep Form

1) How are you feeling physically? Where are you experiencing tension/aches/pain? Explain other physical symptoms (fatigue, digestive issues, headaches, etc.).

2) What are your biggest emotional challenges/blockages (anxiety, grief, fear, unworthiness, guilt, shame)?

3) Where are you currently feeling stuck (ex. in a relationship, in your career, life purpose)? What are your current challenges?

4) What are your goals over then next 3 months (in any area of your life)?

5) Is there anything you want to make sure to cover or address during our session?

Cancellation Policy:
Please be aware that I have a 24-hour cancellation policy. If you cancel within the 24-hour window, you are responsible for half the price of the session. If you do not show up for a scheduled appointment, you are responsible for the full price of the session. Exceptions made for illness or emergencies, however you must call or text Molly at 720-402-9985 to be eligible.

Late Policy:
If you are late for your session, you will receive the remaining amount of time and you will still be responsible for the full payment of the scheduled session.

I understand that if I experience any pain or discomfort during the session, I will immediately inform the therapist so that the pressure and/or technique can be adjusted to my level of comfort. I further understand that massage is not a substitute for medical examination, diagnosis, or treatment and that I should see a physician or qualified medical specialist for any mental or physical aliment that I am aware of. I understand that massage therapists are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness. Because massage should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile.

Thank you! Looking forward to our upcoming session!

Thanks for submitting!

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