Massage Intake and Liability Release Form


Massage Intake Form

Please fill the form before your session.
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Medical Information



Massage Information




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Liability Release

By signing below, you agree to the following: 1) I give my permission to receive massage session. 2) I have clearance from my physician to receive massage. 3) I understand the risks associated with massage therapy include, but are not limited to: • Superficial bruising • Short-term muscle soreness • Exacerbation of undiscovered injury I therefore release the company and the individual massage practitioner from all liability concerning these injuries that may occur during the massage session. 4) I understand the importance of informing my practitioner of all medical conditions and medications I am taking, and to let the practitioner know about any changes to these. I understand that there may be additional risks based on my physical condition. 5) I understand that it is my responsibility to inform my practitioner of any discomfort I may feel during the massage session so he/she may adjust accordingly. 6) I understand that I or the masseur may terminate the session at any time. 7) I have been given a chance to ask questions about the massage therapy session and my questions have been answered.

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