CONSENT FOR SERVICES
I hereby consent to receive one or more of the following professional services provided by the practitioner:
☐ Massage Therapy
☐ Facial Treatment
☐ Body Treatment (e.g., body wrap, body scrub, etc.)
I understand that the services I receive are intended to promote relaxation, stress reduction, and/or skincare, and are not a substitute for medical care. I understand that licensed professionals do not diagnose or treat illness, disease, or other physical or mental disorders.
I agree to inform my service provider of any discomfort or concerns I experience during the session and understand that communication is essential for safe and effective treatment.
MEDICAL DISCLOSURE
I confirm that I have disclosed any relevant medical conditions, injuries, allergies, pregnancy, skin sensitivities, or current medications that could impact the safety or outcome of the treatment(s).
I agree to keep my provider informed of any changes in my health status.
Before my first session, I have provided full disclosure of my relevant medical history, including but not limited to:
- Purpose of visit
- Any pain or discomfort and its location
- Allergies (e.g. oils, latex)
- Current medications and treatment providers
- Past surgeries, injuries, pre‑existing conditions
- Pregnancy or skin sensitivities
RELEASE OF LIABILITY
By signing this form, I voluntarily agree to assume all risks associated with the services provided. I hereby release, waive, discharge, and hold harmless the practitioner and the facility, its employees, agents, and affiliates from any and all liability, claims, demands, damages, or causes of action that may arise from services received, except in cases of gross negligence or willful misconduct.
I understand that although rare, some side effects such as redness, irritation, muscle soreness, or allergic reaction may occur and that I assume full responsibility for any such outcomes.
In consideration of services received, I voluntarily waive, release, and forever discharge the practitioner and facility (including employees and agents) from all liability for damages, claims, or causes of action arising out of or relating to services provided—except in cases of gross negligence or intentional misconduct.
I acknowledge the risks inherent in massage, facial, and body treatments (e.g. redness, muscle soreness, skin irritation, allergic reaction) and assume full responsibility for any outcomes.
RIGHT TO REFUSE SERVICE
The practitioner and/or facility reserves the right to refuse or discontinue service at any time for any reason, including but not limited to:
- Health or medical contraindications
- Inappropriate behavior or language
- Intoxication or drug use
- Personal or professional boundaries
- Clients who exhibit inappropriate conduct will be asked to leave immediately and may be prohibited from returning. Any such refusal does not waive my financial responsibility for scheduled appointments, per the cancellation policy.