Pain Is Not A Game, We Find & Fix!

Policies & Forms

Below you will find our basic policies from booking, refunds, conduct, and privacy. Also, below you will find our online or fillable and printable intake form, and HIPAA form. 

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Important Documents

Forms & Documents

When you book and appointment with us using our booking provider, Massage Book, you will automatically be emailed our standard new patient onboarding form. This form is important and will give us a better idea of your situation and your treatment goals. Please fill out that form completely. Depending on your situation, we may ask you to fill out other forms such as our HIPAA privacy, or other forms. Below you will find those forms. Below you will find both online, and downloadable forms. You may choose to submit online or print them and bring them to your appointment. All forms are stored on a secured server and will protect your privacy.

Online Forms

All Forms Submitted Online Are Stored On A SECURED Server. New Patient Intake Forms Are Emailed Upon Booking

Downloadable Forms

All Forms Are In PDF Format And Fillable

How To Book

Booking & Payment Policies

Schedule Your Appointment

Make an Appointment

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Ethical and Professional

Practice Ethics & Conduct Policy

Conduct Policy

Our practice is a professional and medical practice. We operate under a strict code of ethics we abide by every day. We expect patients of Diligent Medical Massage to conduct themselves in a courteous manner. The following behaviors WILL NOT BE TOLERATED, and may result in being asked to leave, be suspended from our practice, or prosecuted to the fullest extent of the law.

  • Under no circumstances does the practitioner perform “happy endings”, do not even try to ask for one.
  • The practitioner is happily married, do not ask for a date or make any advances.
  • Aggressive behavior WILL NOT be tolerated.
  • Foul Language WILL NOT be tolerated.
  • The property employs the use of LIVE surveillance cameras and is externally monitored while we have a patient. Your privacy is respected in the treatment room, but my safety and security is first and foremost.
  • The facilities are my home, theft of my property will be prosecuted to the fullest extent.
  • Weapons are not allowed on our property, however there are weapons on the property and will be used under the fullest extent of the law to protect my life and security.
  • I am blind, but I am not stupid. If you are a patient I allow to pay by cash, the money will be counted by a person with sight. If you attempt to take advantage of my sight and short change me (ex: pay with $1 bills instead of $20 bills), you will permanently be discharged from my practice and any amount owed will be due immediately and sent to a collection agency.

Code of Ethics

While I was in massage school, one of my assignments was to write a code of ethics for my future practice. Running an ethical practice is of uttermost importance to me. Over the years, I kept this assignment framed and posted in my treatment area. I wanted this included on my website.

My Ethical Code 

Elizabeth A. Dodd LMBT

  • I will treat my patients with the utmost dignity and respect.
  • I will hold myself to a higher standard than required.
  • I will to the best of my ability help my patients get the relief they seek, even if I must refer them to someone who practices outside of my scope of practice.
  • My patients will have my undivided attention.
  • I will provide a safe and comfortable environment for my patients.
  • I will respect my patient’s boundaries and confidentiality.
  • My personal moral code will not be compromised.
  • I will always give my best, every day, every time.
  • I will always be transparent.
  • I will ensure my patients fully understand their treatment plan.

 

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