I understand that the Manual Lymphatic Drainage I receive is provided for the basic
purpose of improving the flow of my lymphatic system and also for relaxation. If I
experience any pain or discomfort during this session, I will immediately inform the
technician so that the pressure and/or strokes may be adjusted to my level of comfort.
I further understand that massage or bodywork should not be construed as a substitute
for medical examination, diagnosis, or treatment and that I should see a physician,
chiropractor, or other qualified medical specialist for any mental or physical ailment of
which I am aware. I understand that massage/bodywork practitioners are not qualified to
perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or
mental illness, and that nothing said in the course of the session given should be construed
as such.
Because massage/ bodywork should not be performed under certain medical conditions, I
affirm that I have stated all my known medical conditions and answered all questions
honestly. I agree to keep the practitioner updated as to any changes in my medical profile
and understand that there shall be no liability on the practitioner’s part should I fail to do
so.
*Please Note: Manual Lymphatic Drainage (MLD) is a very powerful modality and
certain medical conditions are contraindicated and determine if and when you can receive a
session. After the consultation and review of the information you have provided on this
form, it will be determined if MLD should be administered to you today. Some conditions
will require a note from your doctor before proceeding. Please understand this is for your
safety and well-being. Your health is important to me. Please also Note that 1208 Beauty Bar can only delive this service to Women at this time.
Client Signature _____________________________________Date ____