Massage Informed Consent & Liability Waiver
Please complete this form to provide your consent and health information for massage services at Luana Massage.
Client Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Informed Consent and Liability Waiver
Consent to Massage Treatment:
I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow.
Risks and Benefits:
I acknowledge that there may be risks associated with massage therapy, including but not limited to soreness, bruising, or aggravation of existing symptoms. The benefits may include reduced stress, pain relief, and increased mobility.
Not a Substitute for Medical Care:
I understand that massage therapists do not diagnose illness, disease, or any other physical or mental condition. Massage is not a substitute for medical examination, diagnosis, or treatment.
Client Responsibility:
I agree to inform my massage therapist of any changes in my health status and understand that it is my responsibility to keep my therapist updated.
Liability Waiver:
I hereby release Luana Massage and its therapists from any and all liability, claims, or demands arising from ordinary massage services.
By signing below, I confirm that I have read, understood, and agree to the above statements.
Client Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consent
Submit Consent
Should be Empty: