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Massage Therapy Consent Form

Thank you for choosing our massage therapy services. Please complete this form, as it provides important information for your safety and the effectiveness of your treatment.

Medical History











Current Symptoms or Concerns

Consent and Agreement

1. I understand that massage therapy is intended to enhance relaxation, reduce pain, and provide stress relief, but is not a substitute for medical examination, diagnosis, or treatment. I will inform the therapist of any pain or discomfort immediately during the session.

2. I affirm that I have stated all known medical conditions and answered all questions honestly. I agree to keep the therapist updated on any changes to my health status and understand that there shall be no liability on the therapist’s part should I fail to do so.

3. I acknowledge the policy requiring a 24-hour notice for cancellations or rescheduling. If I fail to provide at least 24 hours’ notice, I understand that I will be charged a $50 cancellation fee.

4. I voluntarily agree to receive massage therapy treatment and understand that I can ask questions at any time about the techniques used and request adjustments as needed.