Massage Club Contract

Please feel free to look over the contract before deciding to commit. If you have any questions please don't hesitate to call our office.

Massage Club Contract

This Massage Club agreement is entered into as of ______________(date), between Wilson Chiropractic & Wellness, LLC and _______________________________(full name).

This agreement is being entered into for the purpose of ________________(name), to purchase and receive no less than one (1) massage every month for 12 months, with each massage being $50.00 for a total of $600 ($50X12) in a year. Any additional massage are an additional $50 each.

___ This price per massage cannot be combined with any other discounts, coupons, or specials.

___ If you miss a massage for the month (without previously discussing with the office) your card will be charged and the massage can not be made up later.

___ Massage hours can not be combined to make a 2(+) hour massage.

___ There is a 24 hour cancellation policy for any massages scheduled. If you can not give a 24 hour notice or fail to give any notice there will be a 50% charge of $25 that will need to be paid before any more massage can be received. If the fee isn't paid before any of your next scheduled massage(s) those massage(s) will be for-fitted and charged to your card / account in addition to the cancellation fee.

___ If you are running late, your massage time will be shortened by the time you are late, up to 30 minutes. If you are over 30 minutes late you will either have to pay for and for-fit the massage or pay a $25 charge and reschedule your massage.

___ If you are planning on going out of town or need to take a break from the massage club, you can put your account on hold anywhere from one (1) month to six (6) months. Either all at once, month by month or however you desire. If you choose to place your massage club on hold we will need a written notice two (2) weeks in advance for the hold to take effect.

___ If you would like to split the massage club contract with your spouse / child / family member (such as mother, sister, brother) you can do so by filling out and signing the "additional persons" section of this contract, with a maximum of 4 people per plan.

___ If you would like to cancel your massage club contract there will be a fee of 50% of whatever has not been used, unless, you permanently move farther than a 15 mile radius of the office, or have a signed Doctors statement explaining that you are no longer to receive massage. All membership cancellations require 30 days written notice and are effective 30 days after the date received. Payments due prior to the effective date of cancellation will be charged as scheduled.

___ Upon termination or cancellation of membership, all unredeemed massages will expire.

___ Another Massage Club agreement cannot be entered until the fulfillment of the previous one.

___ At any time the Office has the rite to cancel your membership for any reason. If the office should cancel your contract you will not be reimbursed for any received massages but will not be held accountable for the rest of the contract.

By signing below, I authorize Wilson Chiropractic & Wellness, LLC to charge to the account I have specified. Monthly dues and / or renewal fees will be withdrawn on or after the same day of each month. I understand that Wilson Chiropractic & Wellness, LLC may continue to charge my account or cancel my membership in accordance with the terms and conditions of this agreement. Additionally, I authorize Wilson Chiropractic & Wellness, LLC to charge my credit card on file in lieu of presenting it for any services received, at my request.

We agree to sell and you agree to purchase the membership, good and services described herein. You agree to pay us for the membership, goods and services according to the payment schedule below. Your signature below indicates your agreement to be bound by the terms and conditions, rules and regulations of this agreement. All persons signing this agreement are equally responsible for paying it in full.

You have elected to pay your membership: __ on a monthly basis __ paid in full total $______

Your membership term begins on _______________ (date) and expires on _____________ (date).

Your membership dues of $50 will be due on the ______ day of the month and then due on or after the same day of each month hereafter until your membership expires or is terminated in accordance with this agreement.


Name (print) _______________________________________

Signature _________________________________________

Address ____________________________ ______City ____________________

Zip code ________

CC Type __________ CC Number ______________________________________

CC Exp Date _________ CC CVC code _______

ID (checked by office personnel) ______

Additional Persons (if minor please fill our parental consent form with front desk)

Name ______________________________ Signature ______________________

Name ______________________________ Signature ______________________

Name ______________________________ Signature ______________________


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  • "I have completed ten weeks of treatment and am happy to report I am able to be pain free."
    Samuel J Gallegos - Westminster, CO