Member Registration – AIM Wellness Membership

I am interested in becoming a(n) *

Individual Member
Professional Member

For my *

Workplace Wellness Program
Social Network

Company Name *

Network Name *

Your Name *

First

Last

Layout

Email *

Phone Number *

Password *

Password

Confirm Password

Birth Date *

Emergency Contact *

First

Last

Phone

Though we do not hope for or anticipate incidents to occur during a session, it is important for us to have record of who to contact in case of an emergency. Learn more

I am authorized to schedule wellness sessions on behalf of the above mentioned company/network.

Who referred you to the AIM Wellness Membership program?

Primary Session Location *

Any parking or location notes we should be aware of? Choose all that apply. *

Layout

Is there a $ parking fee? *

What is the $ parking fee? *

What animals/pets should we be aware of? *

How many stairs/flights are required? *

What other parking/location notes should we be aware of? *

What best describes your workplace wellness goals? Choose all that apply. *

What other workplace wellness goals do you have? *

What best describes your social network wellness goals? Choose all that apply. *

What other social network wellness goals do you have? *

How many people part of your company are to receive wellness treatments from AIM? *

Cannot exceed 50

How many people part of your network are to receive wellness treatments from AIM? *

Cannot exceed 50

“I am hopeful AIM Massage Therapy can help me with the following wellness goals.” Choose all that apply.

What areas would you like targeted? Choose all that apply. *

What other wellness goals do you have? *

Do you have any known allergies to oils, lotions or ointments? *

What oil, lotion or ointment allergies do you have? *

Do you have any health conditions we should be aware of? Choose all that apply. *

AIM Massage Therapy will not provide Services to Members who are experiencing a contagious viral or bacterial infection. Learn more

Receiving a massage can further irritate an inflammed area. In the case of localized inflammation, the affected area will be completely avoided. Learn more

For Members with visible skin conditions such as bruises, wounds or rashes, AIM Massage Therapy will avoid the affected areas. Learn more

For Members experiencing nerve damage, i.e. neuropathy, AIM Therapists will use caution in these areas and recommends gentler Therapeutic Massage and Bodywork techniques. Learn more

For some people, the use of therapeutic treatments, including aromatherapy, can cause a state of deep relaxation that can trigger a seizure. Learn more

AIM Therapists will use caution for Members experiencing conditions that affect blood regulation such as blood pressure, diabetes and/or blood clotting. Learn more

For Members experiencing breathing difficulties, care is taken in the type of modality used for treatment to maximize comfort. Learn more

Therapeutic Massage and Bodywork treatments can affect your heart and circulatory system resulting in modified or avoided treatment. Learn more

Members with inflammatory/autoimmune diseases such as rheumatoid arthritis and lupus should inform their Therapist of any symptoms they are experiencing as certain techniques may cause flare-ups. Learn more

To prevent fracturing, gentle techniques will be used for Members who are at high risk of breaking a bone. Learn more

AIM Massage Therapy will not provide Services to Members who are currently undergoing radiation or chemotherapy treatments or Members with highly metastatic cancers. Learn more

Treatment is completely contraindicated for Members during the first couple of weeks to months after a stroke or heart attack. Learn more

AIM Massage Therapy will not provide Services to Members who were recently involved in a traumatic accident or recently had major surgery. Learn more

AIM Massage Therapy will not provide Services to women who are in their first trimester of pregnancy or are experiencing a high risk pregnancy. Learn more

AIM Massage Therapy will not provide Services to Members experiencing severe, unexplained or undiagnosed ongoing symptoms. Learn more

Emotional and mental trauma expresses through the body in many ways, and may cause Members to have an uncomfortable session experience. Learn more

What health conditions we should be aware of? *

Please note that a Health and Safety Liability Form will be issued before each session and will require signature.

Refer to our full Terms and Conditions before continuing.

I certify that I am at least 18 years old and that I read, understand and agree to AIM’s Terms and Conditions.