By typing my first name, last name, and providing my e-signature below, I am indicating the following:
I understand that Delia Ahouandjinou LMT, CST, does not diagnose illness or disease or other medical, physical or emotional disorder, nor prescribe any medications/treatments. I acknowledge that I am responsible for consulting a qualified physician for any ailments that I may have. If necessary, I allow Delia to discuss with my health care provider the appropriateness of bodywork for my condition.
I have read the New Client Intake Form for Delia Ahouandjinou, LMT CST in its entirety.
I fully understand all questions and information provided in the New Client Intake Form for Delia Ahouandjinou, LMT CST.
I have completed the New Client Intake Form for Delia Ahouandjinou, LMT CST accurately and to the best of my knowledge.
I have read, I understand and I agree to the terms and conditions to receive a session from Delia Ahouandjinou, LMT CST.
I shall take it upon myself to inform Delia Ahouandjinou LMT, CST of any changes.
If I experience any pain or discomfort during this session, I agree to immediately inform Delia so that the pressure and/or methods can be adjusted to my comfort level. The therapist reserves the right to refuse services for any reason of safety.