Client Waiver Form
Please take a moment to agree to the following terms:
If I experience pain or
discomfort during the session, I will immediately inform my
therapist so that pressure/strokes can be adjusted to my level of
comfort. 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 today are not a substitute for medical care. I
understand that my therapist is not qualified to perform spinal or
skeletal adjustments, diagnose, prescribe, or treat physical or
mental illness.
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.
In the interest of accommodating and respecting all involved, 48hr
notice is needed to cancel a scheduled appointment or
change a scheduled appointment. If 48hr notice is not given,
the cost of the treatment will be charged to the client. If another
client is able to fill the appointment time, the cost of the
treatment will be waived and will be replaced by a $10 office fee. A
credit card will be provided and kept on file for collecting
payment. If the client is not able to commit to a scheduled time,
they can ask to be placed on a wait list and will be contacted if an
appointment time becomes available.
Typing your full name below will act as your signature: