YOU

Please take a moment to carefully read the following information and sign where indicated. If you have a specific medical condition or specific symptoms, massage/bodywork may be contraindicated. A referral from your primary care provide may be required prior to service being provided.

Massage/Bodywork Consent

I acknowledge and understand the following:

1. I understand that massage/bodywork is intended for relaxation and relief of muscle tension. If I experience discomfort or pain, I will inform the practitioner immediately to adjust pressure or technique.

2. I acknowledge that massage is not a substitute for medical care and that the practitioner does not diagnose or treat medical conditions. I agree to consult a qualified healthcare provider for any health concerns.

3. I confirm that I have disclosed all relevant medical conditions and will update the practitioner of any changes. I understand the practitioner is not liable for issues arising from undisclosed health information.

4. I understand that any inappropriate behavior, including sexual remarks or advances, will result in immediate termination of the session, and I will be responsible for full payment.

Consent to Treatment of Minor:

(under age 18, parents must sign)

By my signature below, I hereby authorize administering of massage, bodywork, or somatic therapy techniques to my child or dependent as they deem necessary.