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Client Intake & Liability Waiver

Please submit prior to your first appointment.

Birthday
Month
Day
Year
Do you currently have any of the following?
Do you have allergies, sensitivities, or aversions to any of these?
Pressure Preference

Liability Waiver

  • I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow.

  • If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.

  • I understand that the services offered are not a substitute for medical care. I understand that my therapist is not qualified to diagnose, prescribe, treat physical or mental illness, or perform spinal or skeletal adjustments.

  • I affirm that I have notified my therapist of all known medical conditions and injuries.

  • I agree to inform the therapist of any changes in my health and medical condition. I understand that there shall be no liability on the therapist's part should I forget to do so.

  • I understand that massage is entirely therapeutic and non-sexual in nature.

  • By signing this release, I hereby waive and release my therapist from any and all liability, past, present, and future relating to massage therapy and bodywork.

  • I have received the policy statement and have read and agree to the policies therein.

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