Client Intake Form | Genie Hands LLC

Section 1 — Client & service location Your details & where we’ll meet you

Important Information

Travel Policy and Service Area Notice

Please note that a travel fee starting at $15 will apply for appointments outside of my standard service areas, which include: Pinecrest, South Miami, Kendall, Sunset, Miami, North Miami, North Miami Beach, Miami Gardens, Aventura, Pembroke (near I-95), Hallandale and Miramar (near I-95). Customer must also pay any parking fees.

For post-surgical clients, it is strongly recommended to stay within 10–15 miles of your surgical clinic, as Miami traffic, particularly during peak hours, can be unpredictable and cause delays.

Due to consistently heavy traffic and limited accessibility, we do not service the following areas:

Beaches: South Beach, Miami Beach, Sunny Isles Beach, Hallandale Beach, Hollywood Beach, etc.
Downtown and Brickell

Services are provided at a location you choose. You agree the space is safe, clean, and suitable. We are not responsible for environmental hazards, unsafe conditions, or third-party actions. You are responsible for parking and access. We may refuse or end a session if the environment is unsafe.

These summaries do not replace the full Terms & Conditions.

Full name *

Phone number (text or call) *

Email *

Which service area are you in? *

Helps us route sessions efficiently. If you’re between zones, choose the closest match.

Street address *

City, state & ZIP *

City

State

ZIP

Building access & parking notes (optional)

Emergency contact — full name *

Emergency contact — phone *

* I understand travel fees may apply depending on location and will be confirmed before the appointment is finalized.

Section 2 — Service & scheduling Session type, availability & how to reach you

Important Information

All appointments are subject to approval. We may adjust timing or decline a booking for safety or capacity. Late arrivals may shorten your session; the scheduled fee still applies. Booking and confirmation requirements are summarized again in Section 4.

These summaries do not replace the full Terms & Conditions.

Service requested *

Number of sessions

Preferred days of service *

Select all that apply. Time windows below follow weekday vs. weekend selections.

Are your dates flexible if we need to adjust?

Yes No Somewhat

Preferred contact method *

Text Phone call Email

Section 3 — Medical intake Safety & suitability

Important Information

Please answer accurately and completely. This information is for your safety and to confirm services are appropriate. Risks, liability, and detailed policies are in Section 4 and the full Terms & Conditions.

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

Yes No

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 *

Days post-surgery (if applicable; otherwise N/A)

Section 4 — 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 booking.

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

Section 5 — Payment, uploads & signature Deposit, ID verification & e-signature

Payment instructions

Deposit: $100 (non-refundable). It is applied toward your total; remaining balance is due as required before or at service. Failure to complete payment may cancel the appointment or forfeit the deposit.

Send via Zelle or Cash App: 954-669-4459

After sending your deposit, upload:

Payment confirmation screenshot
Valid photo ID

Your appointment will only be confirmed once all required items are received and verified.

Privacy: Information you provide is used for service delivery, scheduling, and communication, and is kept confidential except as required by law.

Upload deposit confirmation *

Screenshot or PDF; one file.

Upload valid government-issued photo ID *

JPEG/PNG or PDF; one file.

* I confirm the deposit has been submitted and both payment proof and ID are uploaded above.

Electronic signature — type your full legal name as shown on ID *

Today’s date *

Set automatically to today’s date on your device.