I understand that the massage I will be receiving is for the purpose of stress reduction, relive from muscular tension or spasm. I understand that the massage therapist does not diagnose illness, disease, or any further physical or mental disorders. As such, the massage therapist does not prescribe medical treatment or pharmaceuticals, nor do they perform spinal manipulations. I understand that massage is not a substitute for medical treatment or diagnosis and that it is recommend that I see a physician for any physical ailments that I may have. I acknowledge that the information I have provided on this form is correct and current to the best of my knowledge. I understand that it is my responsibility to inform the massage therapist of any changes to this information. I understand that if I experience any unusual discomfort and/or pain during my massage sessions it is my responsibility to inform the massage therapist so they can adjust the pressure or technique being used. I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.

All written records and massage sessions are kept strictly confidential and will not be shared with any outside establishment, individuals, organizations or medical facilities without explicit written consent from the client (you) or the client’s legal guardian. Unless legally required by local, state, or federal subpoena, summons, or other court order.