ACKNOWLEDGE & CONSENT
In order to serve you better, please read the information below:
1) I give my permission to receive massage therapy.
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 acknowledge that it is my sole responsibility to secure any and all medical clearances to receive massage
5) I understand the risks associated with massage therapy include, but are not limited to:
• Superficial bruising
• Short-term muscle soreness
• Exacerbation of undiscovered injury
I therefore release the company 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 accordingly.
8) I understand this is professional business with a strict policy prohibiting harassment of employee or unlawful
9) I acknowledge that I have sufficient understanding of massage therapy, and I have been adequately informed
and provided sufficient opportunity to ask questions. I hereby give my informed consent to receive massage
10) I understand that I or the massage therapist may terminate the session at any time.