It is my choice to receive massages and I understand that treatments and/or techniques are being given for the well-being of my body and mind. Because massage therapy should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly and completely. I understand the massage services are designed to be a health aide and do not, in any way, take the place of a doctor's care. I understand that the massage practitioners at M3: Modern Massage Masters, LLC do not diagnose or prescribe or do anything outside of the scope of massage, such as skin care or chiropractic. I agree to hold harmless the massage therapist, the staff and the business for any and all injuries or losses that may occur at the premises of the business.

Not fully reading or understanding this form is not to be an acceptable excuse. I have completed this form, including the client intake medical history form, to the best of my knowledge and agree to keep it and all massage practitioners updated each and every time I am in a situation where I may be touched. Information exchanged during the massage session is educational in nature, intended to help me become more familiar and conscious of my own health, and is to be used at my own discretion with my own medical advisors. I agree to hold the business and the practitioner harmless from any injuries and I accept any and all risks involved. I hold the massage therapist harmless in all situations.

I understand and agree that the massage therapy given here is for the purpose of stress reduction, relief from muscular tension or spasm, or for increasing circulation and in no way takes the place of a doctor's care. I understand the massage therapist does not diagnose illness, diseases, or any other physical or mental disorder. As such, the massage therapist prescribes neither medical treatment, nor pharmaceuticals and does not perform any spinal manipulations. It has been made very clear to me that this massage therapy is not a substitute for medical examinations and/or diagnosis and that it is recommended that I see a physician for any physical ailment that I may have. I agree that the session is for relaxing the client and client's muscles only.

Because a massage therapist must be aware of existing physical conditions, I have stated all of my known medical conditions and take it upon myself to keep the massage therapist update on my physical health each and every time I an in a touch situation. If I need extra sheets to write on, I will ask for them. I agree to keep each and every therapist informed and updated in writing and verbally every time I am in a position that I may be touched within the business premises or at an M3: Modern Massage Masters, LLC event. I understand and agree not to ever let them touch me unless I am absolutely certain that I am healthy enough to receive massage without a chance of injury. In fact, I, the customer/ client will not even get on the table if I am not extremely healthy.

I am required to consult with my physician if I have any significant injury/accident history and to get a complete physician's release/ consent prior to receiving the massage or training. The burden of screening problem areas and contraindications is on the massage client and his/her physician. A sample list of contraindications are available upon request if you did not receive one - feel free to ask your massage therapist.

I, the client, do hereby hold the massage therapist and the staff harmless from all judgements, decisions and actions related to the visit, the massage and relating to issues about preexisting or non-preexisting conditions. I understand that during a massage service a technique may not be implemented optimally and mistakes may or may not occur, but as the client, I accept all risk and waive all rights in the case of injury or loss. I certify that I am healthy enough and have the responsibility to obtain my own healthcare and health care advice from sources other than the massage therapist, including a physician. I agree that if I have any vertebrae or vertebrae disk problems, I will not receive a massage, but in the event that I do receive massage, I specifically hereby hold the massage therapist, business and the staff harmless from any injury or loss relating to the vertebrae and the area including nerves.

I, the client, agree to the following: Even when proper massage techniques are used, disks and vertebrae that are compromised, weakened or damaged may continue getting worse immediately or over time and the massage therapist, business and staff are not - and shall not be - held liable or responsible in any way. If I take any legal action against the massage therapist, business or staff, I agree to limit any and all claims to $25. In case of injury, alleged injury or negative outcome from a massage event, I do hereby authorize M3: Modern Massage Masters, LLC to obtain any and all medical records as well as authorization to conduct a personal and criminal background check on me.

I, as the customer/client, do hereby certify that I have not been charged, convicted, or pleaded on any of the following: Felony, fraud, Felony Insurance Fraud, sexual-related crimes or false statement crimes. In addition, I agree to fully inform M3: Modern Massage Masters, LLC about any previous personal injury claims of my past and agree not to get on the table without specific written permission from my designated official if I have a criminal or personal injury record/ history.

I certify that I am not on any medication that would dull my senses or be contraindicated for receiving massage therapy. I acknowledge and agree to abide by M3: Modern Massage Masters, LLC's "2nd Rule" which is summarized by the following:

1. Clients are required to be responsible for their own health and protection
2. Clients are not to get on a table if they are not fully healthy enough
3. If I want someone to stop touching me/ stop doing a specific technique, or if what the massage therapist hurts/ could potentially hurt me, I am required to say, "Stop; don't touch me there" in which your massage therapist should stop immediately to reassess.

(3rd Rule) This phrase must start immediately, but no later than 2 seconds after you figure out that it is a negative situation. The same rule applies if someone is saying or doing something that makes you uncomfortable or offends you - in such cases, I, the customer/ client agree to say, "Stop saying/ doing that. It is offensive to me" in which your massage therapist should stop. If a session is stopped at any point, any party involved including the massage practitioner, the client or staff may choose to end the session. Failure to notify everyone involved quickly about a negative outcome may result in lack of credibility of testimony.

I agree not to save up complaints and to communicate them immediately. Modern Massage Masters, LLC has a zero tolerance rule on sexual harassment and I agree to hold the massage therapist, the business and the staff harmless from any claims and to inform M3: Modern Massage Masters, LLC and the party involved immediately if something is perceived as harassment or potential harassment. I limit any claims in this area to $25.

I acknowledge and agree to Modern Massage Masters policy as follows:
1. Card is required for booking online appointments
2. Prepayment/ deposit fee of 50% of all services are required for reservation
3. Card information will be saved for no-show/ cancellation fees
4. Cancellation/rebooking must occur 24hr before your scheduled appointment. You will be fully charged with no refund available. If you reschedule your service to a later date after the 24hr window policy, you will receive a voucher specific to your previously requested service that will be applied to your next appointment.

This release and agreement is binding each and every visit or interaction with the business, massage therapist, or staff members. I agree to remind each therapist and staff member each and every time I am in a situation where I may be touched.

If any one part of this agreement is determined to be not legal, void or voidable, it shall not affect any other part of this agreement. If there are any conflicts here or elsewhere, the provision that is most favorable to the protection of M3: Modern Massage Masters, massage therapists and staff members is to apply.

I have completed this form and the Client Intake Medical History Form to the best of my knowledge and have been complete. I have indicated in writing any and all significant conditions on the intake form and agree to all conditions on this form.