1. I voluntarily request and consent to receiving massage therapy.

2. I understand that the massage service offered is for the purposes of general wellness, stress reduction, and relief of muscular tension only.

3. I do not have any injuries or conditions that prevent me from receiving massage therapy. I understand the importance of informing my massage therapist of all medical conditions and medications that I am taking, and that there may be additional risks based on my physical condition.

4. If I experience any pain or discomfort, I will immediately inform my therapist so that the pressure or techniques used can be adjusted to my comfort level. I will not hold my massage therapist responsible for any pain or discomfort I experience during or after the session.

5. I understand the risks associated with massage therapy include, but are not limited to, superficial bruising, short-term muscle soreness, and exacerbation of undiscovered injury.

6. I do not have any contagious conditions that may put my massage therapist or other clients at risk.

7. I understand that I or the massage therapist may terminate the session at any time.

8. I have been given the opportunity to ask questions about massage therapy and my questions have been answered.

9. I understand a minimum of 24 hours’ notice is required to cancel or reschedule an appointment. Appointments canceled with less than 24 hours’ notice will be charged 50% of the scheduled service.

10. I understand that the information I provide is confidential and will be used solely for treatment, billing, and healthcare operations. I consent to the collection and secure storage of my health information.

I have been advised of the policies and procedures pertaining to massage and I understand these policies. Information regarding massage in general, benefits, contraindications of massage, and possible alternative therapies have been explained to me. I further understand that massage therapy is not a substitute for a medical examination or treatment, and that I should see a physician or other qualified health specialist for any mental or physical ailment of which I am aware. I understand that massage therapists do not diagnose illness or disease, and nothing said during the massage should be construed as such. My consent is informed and voluntary and I understand that I may withdraw my consent at any time except for actions already taken.