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Massage Intake Form

What type of massage do you have scheduled?

Issues to Address:     In the coresponding sections, describe the areas and sensation(s) that you are experiencing. i.e. tight, sharp pain, sore, bruising, dull ache, etc.

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Existing Conditions:    


Client Waiver Form:     

Please take a moment to read and acknowledge the following information:

  • I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension and improvement of circulation and energy flow. 

  • If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort that I experience during or after the session. 

  • I understand that the services offered today are not a substitute for medical care. I understand that my therapist is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness. 

  • I affirm that I have notified my therapist of all known medical conditions and injuries. 

  • I agree to inform the therapist of any changes in my health and medical condition. I understand that there shall be no liability on the therapist's part should I forget to do so. 

  • I understand that massage is entirely therapeutic and non-sexual in nature. 

  • I understand that if the therapist feels a remark or action made by the client is threatening, harrassing or sexual in nature, the session will end immediately and the session will be charged at full price. 

  • I understand that, because massage therapy work involves maintained touch and close physical prosimity over an extended periof of time, there may be an elevated risk of disease transmission, including COVID-19.

  • By Signing this release, I hereby waive and release my therapist from any and all liability, past, present, and future relating to massage therapy and bodywork.

Thanks for submitting!

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