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Client Intake and Waiver Form

Please complete your intake form & save time on your upcoming appointment.

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Issues to Address

Medical History

COVID-19 SYMPTOMS: Please check the box below if any of the following are true:

  • Have had a fever within the last 24 hours

  • Recently experienced respiratory/flu symptoms, sore throat, or shortness of breath

  • Contact, within the last 14 days, with anyone diagnosed with COVID or related symptoms

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Client Waiver Form

Please take a moment to read and initial the following information:

  • 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 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.

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