Returning Guest Intake Form

If you have certain medical conditions or symptoms, receiving a massage may aggravate or worsen that condition. If you are experiencing a cold, fl u, fever, or have consumed alcohol in the past 12 hours, your session must be rescheduled for 48 hours after symptoms disappear. By signing below, I am stating that I understand there are benefits and risks of massage therapy. I understand that massage is not a replacement for medical care, or medical examination. I acknowledge that any recommendation made by my massage therapist is not considered a medical diagnosis, or advice and that there is no stated promise of success of techniques, or services. I have listed all medical conditions (including past conditions, such as operations) that I am aware of and this information is true and accurate to the best of my knowledge. Before beginning a future session, I agree to inform the massage therapist immediately of any change in my health. I acknowledge that this information is confidential and intended for review by massage therapists, that a medical referral may be requested of me, and that LaVida Massage is not liable for the management of any condition whether it is identified or not on this form. This center location is independently owned.

I agree to inform my massage therapist of any discomfort or pain experienced during the session so any adjustments can be made to the pressure, draping or
environment. LaVida Massage is not liable for any injury or condition that arises from the application of massage, despite the completion of this form. This form is only intended as an assessment tool and serves as a guide for the application of massage. All services include 5 minutes for pre-consultation and un-dressing and 5 minutes for post-consultation and re-dressing. I also understand that any illicit or sexually suggestive remarks or advances, made by myself, will result in immediate termination of the session, and that I will be liable for full payment of the session.