By SUBMITTING THIS FORM, you agree to the following:
1) I give my permission to receive massage therapy, facials or waxing services.
2) I understand that therapeutic massage is not a substitute for traditional medical
treatment or medications.
3) I understand that the massage therapist does not diagnose illnesses or injuries,
or prescribe medications.
4) I have clearance from my physician to receive massage therapy.
5) I understand the risks associated with massage therapy, facials, and waxing include, but are not limited to:
• Superficial bruising or redness
• Short-term muscle soreness
• Exacerbation of undiscovered injury
I, therefore, release FUSION DAY SPA and the individual massage therapist from all
liability concerning these injuries that may occur during the massage session.
6) I understand the importance of informing my massage therapist of all medical
conditions and medications I am taking, and to let the massage therapist know
about any changes to these. I understand that there may be additional risks
based on my physical condition.
7) I understand that it is my responsibility to inform my massage therapist of any
discomfort I may feel during the massage session so he/she may adjust
8) I understand that I or the massage therapist may terminate the session at any
9) I have been given a chance to ask questions about the massage therapy session
and my questions have been answered.