Name
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Phone Number
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Format: (000) 000-0000.
Draping
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Minimal
Moderate
Maximum
Consent to massage of the glutes (buttocks)?
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Yes
No
Do any of these apply to you: have any allergies, pregnant or nursing, taking any medications, recent injuries or surgeries, ongoing treatments, skin conditions or skin sensitivities, a cancer diagnosis within the past 6 months, cardiovascular conditions, or any other health concerns I should know about?
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No
Yes
List the specifics:
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Areas to avoid?
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No
Yes
List areas to avoid:
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Client Service Consent Agreement and Release
Updated March 27, 2026 By agreeing, I voluntarily consent to receive massage therapy and bodywork services from Massage by Sean. I understand that these services are intended to promote relaxation, stress relief, and general wellness. Scope of Services I acknowledge that massage therapists do not diagnose medical conditions, prescribe treatment, or provide a substitute for medical care. All services provided are strictly therapeutic and non-sexual in nature. Any inappropriate or sexual behavior will result in the immediate termination of the session without notice or refund. Massage therapy involves physical touch and may be stopped at any time by either myself or the therapist. Draping is required at all times for comfort, safety, and professionalism. I may undress to my personal level of comfort, and towels or sheets will be used for proper coverage throughout the session. Complimentary lounge shorts are available upon request for those who prefer to remain partially clothed. Health & Communication I affirm that I have truthfully disclosed all known medical conditions, injuries, medications, and relevant health concerns, and that the information I provide is accurate and complete. I understand that failure to provide accurate or updated information may affect the safety and effectiveness of my session and release the therapist from any resulting liability. I certify that I am physically able to receive massage or hydrotherapy services and am not currently experiencing any contagious illness, open wounds, skin infections, or other conditions that would make these services unsafe for myself or others. I will inform the therapist if any such conditions arise prior to future appointments. If I experience any pain, discomfort, or sensitivity during the session, I agree to immediately inform the therapist so that pressure, strokes, or techniques can be adjusted for my comfort. Hydrotherapy & Water Safety I understand that body scrub and table shower services are performed as a form of hydrotherapy massage, not as a skincare or medical treatment. These services involve the use of running water, which will be adjusted to my comfort level. The therapist will communicate with me regarding water temperature before and during the session. If I experience any temperature that feels unsafe or uncomfortable, I agree to inform the therapist immediately. It is my responsibility to communicate any discomfort regarding water temperature or pressure during the service. Due to the extensive use of water during body scrub and shower services, surfaces including—but not limited to—the scrub platform, massage table, and flooring may be slippery. I agree to use caution when walking or moving through these areas. Massage by Sean assumes no responsibility for slips, falls, or injuries resulting from failure to use caution. Treatment tables may vary in height based on therapist preference. These tables do not have railings, and I agree to exercise care when getting on, off, or repositioning on the table. Assumption of Risk I understand that massage therapy, bodywork, and hydrotherapy involve inherent physical risks, including but not limited to muscle soreness, allergic reactions, changes in blood pressure, dizziness, or temperature discomfort. By receiving these services, I voluntarily assume full responsibility for any risk of injury, discomfort, or reaction that may occur, except in cases of gross negligence or willful misconduct. Property & Environment I understand that Massage by Sean is not responsible for loss, theft, or damage to personal belongings brought into the service area. I acknowledge that sessions may take place in temporary or mobile settings (such as hotel or studio spaces), and Massage by Sean is not liable for environmental factors beyond reasonable control, including water temperature, pressure, lighting, or facility conditions. Right to Refuse Service Massage by Sean reserves the right to refuse or discontinue service at any time if a client’s health, hygiene, conduct, or behavior is deemed unsafe, inappropriate, or unprofessional. Such decisions are made at the sole discretion of the therapist and may occur without refund. Indemnification I agree to indemnify and hold harmless Massage by Sean and its representatives from any and all claims, damages, or expenses arising from my participation in these services, except in cases of gross negligence or intentional misconduct. Update of Preferences or Client Information I understand that a new intake form may not be completed for each session. I agree to promptly inform the massage therapist of any changes to my preferences, selections, health status, or other information previously provided prior to or at the time of each appointment. Acknowledgment & Release By signing or agreeing electronically, I acknowledge that I understand the nature of massage therapy and bodywork, including hydrotherapy and related risks, and voluntarily consent to receive these services. I hereby release and waive all claims against Massage by Sean and its therapist(s) for any liability, past, present, or future, arising from services received—except in cases of gross negligence or willful misconduct.
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Client Services Agreement and Liability Waiver
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