Client Intake Form

Personal Information

Reason for Visit

Health History

Waiver

Please read and sign:

• 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 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 today's services are not a substitute for medical care and that my therapist is not qualified to diagnose, prescribe, or treat physical/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 and 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 waive and release my therapist from any liability, past, present, and future, relating to massage therapy and bodywork.