Massage Waiver Form

Information and Suggestions

 Prior to your massage, please remove contact lenses and all jewelry. Pull long hair back with a clip or band.

 In general, massage is given while you are unclothed. However, you may choose to wear undergarments or a swimsuit. You will be covered with a top sheet throughout your session. This is your massage and you should be as comfortable as possible.

 Certain types of massage (shiatsu, cranial sacral therapy, reflexology, Thai massage) require loose, comfortable clothing that allow for freedom of motion.

 Feel free to ask your therapist any questions before, during, or after the session. Your therapist is a highly trained professional and will be happy to make you feel informed and comfortable

Name *
Name
Phone *
Phone
Address *
Address
Emergency Contact Phone Number *
Emergency Contact Phone Number
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 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. *
By signing this release, I hereby waive and release my therapist and Amour Soul Space from any and all liability, past, present, and future relating to massage therapy and bodywork.
Date Waiver Signed *
Date Waiver Signed
Digital Signature *
By checking the "Agree" box below I am digitally and legally signing my name to this agreement

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