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New Massage Client Intake form and Consent

Have you ever had a professional massage?
What are your goals today for your massage? Required
Health History
Cardiovascular Required
Head and Neck Required
Musculoskeletal Required
Neurological Required
Respiratory Required
Skin Required
Miscellaeous Required

Waiver

  • I understand that massage therapy is provided for the purpose of relief from muscular tension, improved circulation, relaxation, stress reduction.

  • If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure 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 today's services are not a substitute for medical care and that my therapist is not qualified to diagnose, prescribe, or treat physical/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 and 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 all those working at Nature's Edge Wellness & Spa are independent contractors. Independent contractors are not employees and thus Nature's Edge is not liable for any service completed by them.  Each independent contractor is required to maintain their proper licensing as required by the state of Ohio and also responsible for carrying their own liability insurance and are solely responsible for all services provided and products used.  If they fail to do so they fully accept all legal and financial responsibility should any incident arise.

  • By checking the box I waive and release my therapist from any liability, past, present and future, relating to massage therapy and bodywork

Thanks for submitting!

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