Intake Form
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Massage Consent
I, the undersigned, voluntarily request and consent to receive massage therapy. I understand that massage therapy is intended to promote relaxation, reduce muscle tension, and improve circulation. While massage therapy can provide benefits, I acknowledge that it is not a substitute for medical treatment or diagnoses and should not be used as such.
Acknowledgement of Risk
I understand that there are potential risks associated with massage therapy, including but not limited to:
1. Temporary discomfort, tenderness, or bruising.
2. Exacerbation of pre-existing conditions or injuries.
3. Skin irritation or allergic reactions to massage oils, lotions, or other products used during the session.
I agree to inform the massage therapist of any existing medical conditions, injuries, or sensitivities that may affect the massage session. I understand that it is my responsibility to keep the therapist updated on any changes to my health and to communicate any discomfort during the session.
Medical Disclaimer
I acknowledge that the massage therapist is not a licensed medical doctor and cannot diagnose, treat, or cure any medical conditions. I agree to consult my physician regarding any concerns or conditions before receiving massage therapy.
Release of Liability
I hereby release and hold harmless Blackbird Massage, its employees, and agents from any and all liability for injuries, damages, or complications that may result from receiving massage therapy. I understand that I am responsible for my health and well-being during the session and will communicate any discomfort or concerns immediately.
Michael Gagnon - LMT 139391
Mira Blackbird LLC 2024