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Indemnity Form

Do you have any medical conditions or concerns that you think may be relevant to your massage treatment?(Required)
Have you had any surgeries or injuries in the past 6 months?(Required)
Are you currently taking any medications or supplements?(Required)
Do you have any allergies (eg. latex, essential oils, etc.)?(Required)
Do you experience any chronic pain or discomfort?(Required)
Are there any specific areas of your body you would like the massage therapist to focus on or avoid?(Required)
Are you pregnant?(Required)
Have you received massage therapy before?(Required)
What types of massage techniques have you experienced, and which ones did you find most beneficial?(Required)
Consent & Agreement(Required)
I, the undersigned client, hereby consent to receive massage therapy services from (Your Massage Therapist's Name) at (Your Massage Therapy Practice Name). I understand that the massage session may involve physical touch and manipulation of soft tissues to promote relaxation, stress relief, and overall well-being.
- I acknowledge that I have provided accurate and truthful information about my health history and any concerns or issues that may impact the massage treatment.
- I understand that it is my responsibility to communicate with the massage therapist during the session regarding any discomfort or changes in my condition.
- I release (Your Massage Therapist's Name) and (Your Massage Therapy Practice Name) from any liability related to the massage therapy session or any potential side effects.
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