if (window.location.protocol != "https:" && window.location.href.indexOf("formulate") == -1 && "False" === "True") { window.location.href = "https:" + window.location.href.substring(window.location.protocol.length); } var fbScriptTag = document.getElementsByClassName("cae50cd8-88bc-4469-bcc2-b0fb79007cc0"), fbBodyTag = document.body, fbHeadTag = document.head, fbIsTestResponse = 'False', fbEnableInstaMedScript = 'False', fbRenderContainer = document.createElement("div"), fbRenderedCssContainer = document.createElement("div"), fbConfigScript = document.createElement("script"), fbRequireJSScript = document.createElement("script"), fbInstaMedJSScript = document.createElement("script"), fbGeoCaptchaCallback = document.createElement("script"), fbGeoReCaptchaCallback = document.createElement("script"), fbFormulateRenderer = document.createElement("script"), fbRenderedIntegrations = document.createElement("script"), fbRenderedScripts = document.createElement("script"), fbAutoPopulateFromQueryString = document.createElement("script"), fbEmbeddedCss = "", renderedScripts = 'var conditionalSectionJs = function () {\ requirejs([window.formHost + \'/Scripts/require/fbRequire.config.js\'], function (fbRequireConfig) {\ var fbRequire = fbRequireConfig.fbRequire;\ \ fbRequire([\'jquery\', \'he\'], function ($, he) {\ he.encode.options.decimal = true;\ he.encode.options.allowUnsafeSymbols = true;\ \ var sectionConditions = JSON.parse(\'[{"ElementName":"FormField16_72ab689b-4d56-4cc9-9927-ebbdec04aeb9","Value":"Yes"}]\');\ var conditionOperator = \'and\';\ \ sectionConditions.forEach(function (sectionCondition) {\ $("select[id=" + sectionCondition.ElementName + "]").addClass(\'conditionalSectionListSelection\');\ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']").addClass(\'conditionalSectionListSelection\');\ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']").addClass(\'conditionalSectionListSelection\');\ \ $("select[id=" + sectionCondition.ElementName + "]").on(\'change\', function () {\ checkShowHide();\ });\ \ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']").on(\'change\', function () {\ checkShowHide();\ });\ \ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']").on(\'change\', function () {\ checkShowHide();\ });\ });\ \ function checkShowHide() {\ var shouldShowSection = conditionOperator === \'and\'; /* set default to true for AND operation and false for OR operation */\ \ sectionConditions.forEach(function (sectionCondition) {\ checkSelect(sectionCondition); \ checkCheckbox(sectionCondition); \ checkRadio(sectionCondition); \ });\ \ showHideSection(shouldShowSection);\ \ function checkSelect(sectionCondition) {\ var matchingSelect = $("select[id=" + sectionCondition.ElementName + "]")[0];\ \ if (!matchingSelect) {\ return;\ }\ \ if (matchingSelect.type === \'select-multiple\') {\ var hasOneMatchingValue = false;\ \ for (var i = 0; i < matchingSelect.selectedOptions.length; i++) {\ if (encode(matchingSelect.selectedOptions[i].value) === sectionCondition.Value) {\ hasOneMatchingValue = true;\ }\ }\ \ shouldShowSection = mergeCondition(shouldShowSection, hasOneMatchingValue, matchingSelect);\ } else {\ shouldShowSection = mergeCondition(shouldShowSection, encode(matchingSelect.value) === sectionCondition.Value, matchingSelect);\ }\ }\ \ function checkCheckbox(sectionCondition) {\ var matchingCheckboxes = $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']");\ \ for (var i = 0; i < matchingCheckboxes.length; i++) {\ if (encode(matchingCheckboxes[i].value) === sectionCondition.Value) {\ shouldShowSection = mergeCondition(shouldShowSection, matchingCheckboxes[i].checked, matchingCheckboxes[i]);\ }\ }\ }\ \ function checkRadio(sectionCondition) {\ var matchingRadios = $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']");\ \ for (var i = 0; i < matchingRadios.length; i++) {\ if (encode(matchingRadios[i].value) === sectionCondition.Value) {\ shouldShowSection = mergeCondition(shouldShowSection, matchingRadios[i].checked, matchingRadios[i]);\ }\ }\ }\ }\ \ function mergeCondition(overallResult, newResult, element) {\ newResult = newResult && isParentVisible(element);\ \ if (conditionOperator === \'and\') {\ return overallResult && newResult;\ } else {\ return overallResult || newResult;\ }\ }\ \ function isParentVisible(element) {\ var parentSectionDiv = $(\'#\' + element.id).closest(".fb-section");\ return parentSectionDiv && !parentSectionDiv.is(":hidden");\ }\ \ function encode(myString) {\ myString = he.encode(he.escape(myString));\ \ /* Fixes issues with single quote and backtick encoding */\ var i,\ entities = [\ [\''\', \''\'],\ [\'`\', \'`\']\ ];\ \ for (i = 0; i < entities.length; i++) {\ myString = String(myString).replace(new RegExp(entities[i][0], \'g\'), entities[i][1]);\ }\ \ return myString;\ }\ \ function showHideSection(showSection) {\ if (showSection) {\ $(\'#FormField17_72ab689b-4d56-4cc9-9927-ebbdec04aeb9\').show();\ } else {\ $(\'#FormField17_72ab689b-4d56-4cc9-9927-ebbdec04aeb9\').hide();\ }\ \ $("#FormField17_72ab689b-4d56-4cc9-9927-ebbdec04aeb9 .conditionalSectionListSelection").each(function (i, obj) {\ if (obj.type === \'radio\' || obj.type === \'checkbox\') {\ if (obj.checked) {\ $(\'#\' + obj.id).change();\ }\ } else {\ $(\'#\' + obj.id).change();\ }\ });\ }\ });\ });\ };\ \ fbRequireJSScript.addEventListener("load", conditionalSectionJs);var conditionalSectionJs = function () {\ requirejs([window.formHost + \'/Scripts/require/fbRequire.config.js\'], function (fbRequireConfig) {\ var fbRequire = fbRequireConfig.fbRequire;\ \ fbRequire([\'jquery\', \'he\'], function ($, he) {\ he.encode.options.decimal = true;\ he.encode.options.allowUnsafeSymbols = true;\ \ var sectionConditions = JSON.parse(\'[{"ElementName":"FormField16_72ab689b-4d56-4cc9-9927-ebbdec04aeb9","Value":"No"}]\');\ var conditionOperator = \'and\';\ \ sectionConditions.forEach(function (sectionCondition) {\ $("select[id=" + sectionCondition.ElementName + "]").addClass(\'conditionalSectionListSelection\');\ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']").addClass(\'conditionalSectionListSelection\');\ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']").addClass(\'conditionalSectionListSelection\');\ \ $("select[id=" + sectionCondition.ElementName + "]").on(\'change\', function () {\ checkShowHide();\ });\ \ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']").on(\'change\', function () {\ checkShowHide();\ });\ \ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']").on(\'change\', function () {\ checkShowHide();\ });\ });\ \ function checkShowHide() {\ var shouldShowSection = conditionOperator === \'and\'; /* set default to true for AND operation and false for OR operation */\ \ sectionConditions.forEach(function (sectionCondition) {\ checkSelect(sectionCondition); \ checkCheckbox(sectionCondition); \ checkRadio(sectionCondition); \ });\ \ showHideSection(shouldShowSection);\ \ function checkSelect(sectionCondition) {\ var matchingSelect = $("select[id=" + sectionCondition.ElementName + "]")[0];\ \ if (!matchingSelect) {\ return;\ }\ \ if (matchingSelect.type === \'select-multiple\') {\ var hasOneMatchingValue = false;\ \ for (var i = 0; i < matchingSelect.selectedOptions.length; i++) {\ if (encode(matchingSelect.selectedOptions[i].value) === sectionCondition.Value) {\ hasOneMatchingValue = true;\ }\ }\ \ shouldShowSection = mergeCondition(shouldShowSection, hasOneMatchingValue, matchingSelect);\ } else {\ shouldShowSection = mergeCondition(shouldShowSection, encode(matchingSelect.value) === sectionCondition.Value, matchingSelect);\ }\ }\ \ function checkCheckbox(sectionCondition) {\ var matchingCheckboxes = $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']");\ \ for (var i = 0; i < matchingCheckboxes.length; i++) {\ if (encode(matchingCheckboxes[i].value) === sectionCondition.Value) {\ shouldShowSection = mergeCondition(shouldShowSection, matchingCheckboxes[i].checked, matchingCheckboxes[i]);\ }\ }\ }\ \ function checkRadio(sectionCondition) {\ var matchingRadios = $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']");\ \ for (var i = 0; i < matchingRadios.length; i++) {\ if (encode(matchingRadios[i].value) === sectionCondition.Value) {\ shouldShowSection = mergeCondition(shouldShowSection, matchingRadios[i].checked, matchingRadios[i]);\ }\ }\ }\ }\ \ function mergeCondition(overallResult, newResult, element) {\ newResult = newResult && isParentVisible(element);\ \ if (conditionOperator === \'and\') {\ return overallResult && newResult;\ } else {\ return overallResult || newResult;\ }\ }\ \ function isParentVisible(element) {\ var parentSectionDiv = $(\'#\' + element.id).closest(".fb-section");\ return parentSectionDiv && !parentSectionDiv.is(":hidden");\ }\ \ function encode(myString) {\ myString = he.encode(he.escape(myString));\ \ /* Fixes issues with single quote and backtick encoding */\ var i,\ entities = [\ [\''\', \''\'],\ [\'`\', \'`\']\ ];\ \ for (i = 0; i < entities.length; i++) {\ myString = String(myString).replace(new RegExp(entities[i][0], \'g\'), entities[i][1]);\ }\ \ return myString;\ }\ \ function showHideSection(showSection) {\ if (showSection) {\ $(\'#FormField21_72ab689b-4d56-4cc9-9927-ebbdec04aeb9\').show();\ } else {\ $(\'#FormField21_72ab689b-4d56-4cc9-9927-ebbdec04aeb9\').hide();\ }\ \ $("#FormField21_72ab689b-4d56-4cc9-9927-ebbdec04aeb9 .conditionalSectionListSelection").each(function (i, obj) {\ if (obj.type === \'radio\' || obj.type === \'checkbox\') {\ if (obj.checked) {\ $(\'#\' + obj.id).change();\ }\ } else {\ $(\'#\' + obj.id).change();\ }\ });\ }\ });\ });\ };\ \ fbRequireJSScript.addEventListener("load", conditionalSectionJs);var conditionalSectionJs = function () {\ requirejs([window.formHost + \'/Scripts/require/fbRequire.config.js\'], function (fbRequireConfig) {\ var fbRequire = fbRequireConfig.fbRequire;\ \ fbRequire([\'jquery\', \'he\'], function ($, he) {\ he.encode.options.decimal = true;\ he.encode.options.allowUnsafeSymbols = true;\ \ var sectionConditions = JSON.parse(\'[{"ElementName":"FormField23_72ab689b-4d56-4cc9-9927-ebbdec04aeb9","Value":"Yes"}]\');\ var conditionOperator = \'and\';\ \ sectionConditions.forEach(function (sectionCondition) {\ $("select[id=" + sectionCondition.ElementName + "]").addClass(\'conditionalSectionListSelection\');\ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']").addClass(\'conditionalSectionListSelection\');\ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']").addClass(\'conditionalSectionListSelection\');\ \ $("select[id=" + sectionCondition.ElementName + "]").on(\'change\', function () {\ checkShowHide();\ });\ \ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']").on(\'change\', function () {\ checkShowHide();\ });\ \ $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']").on(\'change\', function () {\ checkShowHide();\ });\ });\ \ function checkShowHide() {\ var shouldShowSection = conditionOperator === \'and\'; /* set default to true for AND operation and false for OR operation */\ \ sectionConditions.forEach(function (sectionCondition) {\ checkSelect(sectionCondition); \ checkCheckbox(sectionCondition); \ checkRadio(sectionCondition); \ });\ \ showHideSection(shouldShowSection);\ \ function checkSelect(sectionCondition) {\ var matchingSelect = $("select[id=" + sectionCondition.ElementName + "]")[0];\ \ if (!matchingSelect) {\ return;\ }\ \ if (matchingSelect.type === \'select-multiple\') {\ var hasOneMatchingValue = false;\ \ for (var i = 0; i < matchingSelect.selectedOptions.length; i++) {\ if (encode(matchingSelect.selectedOptions[i].value) === sectionCondition.Value) {\ hasOneMatchingValue = true;\ }\ }\ \ shouldShowSection = mergeCondition(shouldShowSection, hasOneMatchingValue, matchingSelect);\ } else {\ shouldShowSection = mergeCondition(shouldShowSection, encode(matchingSelect.value) === sectionCondition.Value, matchingSelect);\ }\ }\ \ function checkCheckbox(sectionCondition) {\ var matchingCheckboxes = $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'checkbox\']");\ \ for (var i = 0; i < matchingCheckboxes.length; i++) {\ if (encode(matchingCheckboxes[i].value) === sectionCondition.Value) {\ shouldShowSection = mergeCondition(shouldShowSection, matchingCheckboxes[i].checked, matchingCheckboxes[i]);\ }\ }\ }\ \ function checkRadio(sectionCondition) {\ var matchingRadios = $("input[id^=\'" + sectionCondition.ElementName + "\'][type=\'radio\']");\ \ for (var i = 0; i < matchingRadios.length; i++) {\ if (encode(matchingRadios[i].value) === sectionCondition.Value) {\ shouldShowSection = mergeCondition(shouldShowSection, matchingRadios[i].checked, matchingRadios[i]);\ }\ }\ }\ }\ \ function mergeCondition(overallResult, newResult, element) {\ newResult = newResult && isParentVisible(element);\ \ if (conditionOperator === \'and\') {\ return overallResult && newResult;\ } else {\ return overallResult || newResult;\ }\ }\ \ function isParentVisible(element) {\ var parentSectionDiv = $(\'#\' + element.id).closest(".fb-section");\ return parentSectionDiv && !parentSectionDiv.is(":hidden");\ }\ \ function encode(myString) {\ myString = he.encode(he.escape(myString));\ \ /* Fixes issues with single quote and backtick encoding */\ var i,\ entities = [\ [\''\', \''\'],\ [\'`\', \'`\']\ ];\ \ for (i = 0; i < entities.length; i++) {\ myString = String(myString).replace(new RegExp(entities[i][0], \'g\'), entities[i][1]);\ }\ \ return myString;\ }\ \ function showHideSection(showSection) {\ if (showSection) {\ $(\'#FormField24_72ab689b-4d56-4cc9-9927-ebbdec04aeb9\').show();\ } else {\ $(\'#FormField24_72ab689b-4d56-4cc9-9927-ebbdec04aeb9\').hide();\ }\ \ $("#FormField24_72ab689b-4d56-4cc9-9927-ebbdec04aeb9 .conditionalSectionListSelection").each(function (i, obj) {\ if (obj.type === \'radio\' || obj.type === \'checkbox\') {\ if (obj.checked) {\ $(\'#\' + obj.id).change();\ }\ } else {\ $(\'#\' + obj.id).change();\ }\ });\ }\ });\ });\ };\ \ fbRequireJSScript.addEventListener("load", conditionalSectionJs);'; if(fbScriptTag.length === 0) { fbScriptTag = document.querySelector("script[src*='cae50cd8-88bc-4469-bcc2-b0fb79007cc0']"); } else { fbScriptTag = fbScriptTag[0]; } fbRenderContainer.id = "formRenderContainer"; fbRenderContainer.className = " fbRenderContainer fbRenderContainer_cae50cd8-88bc-4469-bcc2-b0fb79007cc0"; fbRenderedCssContainer.id = "fbRenderedCssContainer"; fbConfigScript.type = "text/javascript"; fbRequireJSScript.type = "text/javascript"; fbInstaMedJSScript.type = "text/javascript"; fbGeoCaptchaCallback.type = "text/javascript"; fbGeoReCaptchaCallback.type = "text/javascript"; fbFormulateRenderer.type = "text/javascript"; fbRenderedIntegrations.type = "text/javascript"; fbRenderedScripts.type = "text/javascript"; fbAutoPopulateFromQueryString.type = "text/javascript"; fbRequireJSScript.src = "https://formulate.geonetric.com/Scripts/require.min.js"; fbInstaMedJSScript.src = "https://formulate.geonetric.com/Scripts/vendor/instamed/token.js"; fbInstaMedJSScript.id = "instamed-sdk"; fbGeoCaptchaCallback.src = "https://formulate.geonetric.com/Scripts/geo-captcha-callback.js"; fbGeoReCaptchaCallback.src = "https://www.google.com/recaptcha/api.js?onload=geoFbCaptchaCallback&render=6LdxkTEpAAAAAMKbkhz8-INpQis_mvSaIXnoyC2V"; fbFormulateRenderer.src = "https://formulate.geonetric.com/Scripts/require/formulate-renderer.js?embeddedCssType=0&isTestResponse=False&hasGoogleAnalytics=False"; fbFormulateRenderer.id = "formulateRendererScript"; fbAutoPopulateFromQueryString.src = "https://formulate.geonetric.com/Scripts/auto-populate-from-query-string.js"; if (fbEnableInstaMedScript === 'True') { fbInstaMedJSScript.setAttribute("data-displaymode", "embedded"); fbInstaMedJSScript.setAttribute("data-environment", "UAT"); fbInstaMedJSScript.setAttribute("data-mobiledisplaymode", "embedded"); } fbGeoCaptchaCallback.onload = function() { if(document.querySelectorAll('.geo-fb-recaptcha').length > 0) { fbBodyTag.appendChild(fbGeoReCaptchaCallback); } } fbRequireJSScript.addEventListener("load", function() { fbBodyTag.appendChild(fbFormulateRenderer); fbBodyTag.appendChild(fbAutoPopulateFromQueryString); }); fbFormulateRenderer.addEventListener("load", function () { initFormBuilderForm(); }); var embeddedCssType = 0 switch (embeddedCssType) { case 1: fbEmbeddedCss = ''; break; case 2: fbEmbeddedCss = ''; break; default: fbEmbeddedCss = ''; } if (fbIsTestResponse === 'True') { fbRenderContainer.setAttribute('data-test-mode', 'true'); } else { fbRenderContainer.setAttribute('data-test-mode', 'false'); } fbRenderContainer.innerHTML = "
\

Required fields are marked with *

\ \ \ \ \ \ \ \ \

Personal Information

We are pleased you have chosen HealthQuest Fitness & Wellness Center for massage therapy.  HealthQuest Fitness & Wellness Center is dedicated to working with individuals who are committed to improving their physical and mental well-being.  Please take a moment to complete the following information so that we may best suite your needs during your massage session.

\ \
\ \
\ \
\ \
\ \
\ \
\ \
\
\
\ \

Health History

Select the date you are currently scheduled for a massage appointment.
\ \
\ \
\ \
\ \
\ \
\ \
\ \
\ \

Policies

Below is information and policies to help you get the most out of your massage experience. Please read carefully and initial each section.

Scope of Practice and Training

Our massage therapists are not licensed to diagnose illnesses or provide medical treatment. Massage Therapy training includes, but not limited to, the following modalities: Swedish Massage, Deep Tissue Massage, Neuromuscular Therapy, Orthopedic Massage, Myofascial Release, Trigger Point Therapy, Advanced Chair Massage and Hydrotherapy.

\ \

Contraindications for Treatment

There are certain conditions in which massage is not recommended, including fever, infection, contagious illness, recent surgery, cancer, open wounds, pregnancy in the first trimester, etc. It is important to disclose all health information on your health intake form. If you have a question concerning a condition, please see a doctor before your massage or your therapist about your concern. It may require that you obtain a written approval from your physician prior to your session. 

If you have recently been diagnosed with COVID-19, you must allow a minimum of 2 weeks from diagnosis and you must no longer be experiencing symptoms in order to attend your massage session.

\ \

Tardiness and Cancellations

Please arrive on time for your session. If you are late your end time will remain the same as if we had started on time as well as the amount billed. Please give 24 hours notice for cancellations or you will be charged for the session. HealthQuest Massage Therapists, reserve the right to request prepayment for future sessions.

\ \

Hygiene

Our therapists will always arrive clean for your massage. We ask that you are clean and free from heavy odors upon arrival for your session. If you exercise prior to your massage session, please shower prior to session and allow time for cool down.

\ \

Confidentiality

Our therapists will respect your privacy and your massage session will remain completely confidential,unless you request otherwise. We will then obtain written permission from you in order to share your personal information.

\ \

Draping

During your session you will be securely draped except for the part of the body that the massage therapist will be working on. As a client,you have the option of disrobing completely or to your comfort level. You will be provided complete privacy to robe and disrobe.

\ \

Your First Session

Your first session will include a consultation to ensure a safe and successful session. During that time we will discuss your health intake form, goals for the session and the massage therapist will answer any questions you may have about the session. This is your session and we are happy to satisfy your requests as long as the request remains within the scope of practice for massage therapy. Please inform your massage therapist if you need an adjustment in pressure or technique to better benefit you. If there is an area of your body that you would like your therapist to spend more or less time on please let them know.

\ \

Client/ Therapist Relationship

Relationships between the massage therapist and clients are strictly professional and therapeutic in nature; therefore the therapist reserves the right to end a session at any time for inappropriate behavior and you will be billed for the full session. Such behavior will limit your ability to return to HealthQuest Fitness & Wellness center for future massage therapy sessions.

\ \

Payment

Payment is expected in full at the time of the service. Payments of cash, check, Visa or Mastercard are accepted at the Reception Desk of HealthQuest Fitness & Wellness Center. Return checks will incur an additional $15 non-sufficient funds fee. Gift certificates must be presented prior to the beginning of each session. Lost or stolen gift certificates cannot be redeemed or replaced.

\ \

I have read and understand the above information.

\ \
\ \
\ \
\
\
"; fbConfigScript.innerHTML = "window.formHost = 'https://formulate.geonetric.com'; window.submissionHost = 'https://formulate.geonetric.com/';"; fbRenderedScripts.innerHTML = renderedScripts.replace(/