Client services and chart information are confidential. Written authorization is required from you to release any information.
• Massage is strictly ethical and professional. Full draping is a must and not an option.
• Any verbal or physical conduct of a sexual nature, including flirting, will constitute as sexual harassment and will not be tolerated.
• Any sexual remarks, requests, or actions, will result in the session being terminated. You will be liable for full payment of the scheduled appointment and may be prosecuted to the full extent of the law.
I understand that close contact with people increases the risk of infection from COVID-19. By signing this form, I acknowledge that I'm aware of the risks involved and give consent to receive a massage from this practitioner.
I understand that my massage therapist does not diagnose illness, disease, any physical or mental disorder, nor she prescribes medical treatment or pharmaceuticals.
I acknowledge that massage therapy is not a substitute for medical examination or diagnosis, and it is recommended that a physician be seen for that service.
It is my choice to receive massage and lymphatic drainage as a form of therapy.
I understand that my insurance will not cover for these therapeutic services and I am responsible for the payment of these therapeutic services.
I also understand that at any time I feel pain or discomfort during the session, I will immediately inform my massage therapist so she adjusts.
I have stated my pertinent medical conditions and will update my massage therapist of any changes in my health status.
I acknowledge that the information that I have provided in this form is correct and current.
I acknowledge that I have read about all the contraindications of massage therapy and lymphatic drainage and I give my consent to receive therapy.
I understand that my failure to do so may post a threat to my health and physical well being and I hold harmless massage therapist Angela Lind from any liability whatsoever arising from failure on my part.
I understand that any inappropriate remarks or advances made by me will result in immediate termination of the session and I will be held liable for payment in full.
I have read or have had read to me the above consent.
By my electronic signature below, I agree to the massage policy and client agreement above.