Massage Liability Release Form

Please fill out the following health declaration form in order to participate in our activity.

Name

Phone Number

Are you experiencing any flu symptoms?

Yes

By signing below, you agree to the following:

I give my permission to receive massage therapy and i have clearance from my physician. I understand that therapeutic massage is not a substitute for medical treatment. I understand that the massage therapist does not diagnose illnesses or injuries. I understand that some of the risks associated with massage are possible bruising, short-term muscle soreness, or exacerbation of undiscovered injury. Therefore, I release Mystic Massage and the individual therapist from all liability concerning the risks that may occur during the massage.

I understand that it is my responsibility to inform the therapist of all injuries present and past and any surgeries and medical hardware. It is my responsibility to inform the therapist of any physical discomfort during the massage so adjustments can be made.

I understand that I or the massage therapist may terminate the session at any time due to inappropriate conduct such as sexual behavior. I have been given a chance to ask questions about the massage and my questions have been answered.

Date

Initials

I confirm that the information given in this form is true