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Client Intake Form

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Bodywork & Massage Consent and Liability Waiver

I understand that the bodywork and/or massage I receive is provided for the basic purpose of relaxation, relief of muscular tension, beauty, and/or overall wellness.


As with any bodywork, aesthetic treatment, or skin product, results vary from person to person depending on lifestyle, genetics, and state of health. Therefore, specific results cannot be guaranteed. I also understand that sensitivity varies from person to person and may vary at different times, even for the same individual.


By signing this agreement, I acknowledge that I am receiving treatment at Center of Mind Body Spirit at my own request and at my own risk.

Clients are instructed on follow-up requirements in order to maintain the bodywork completed. Proper diet, exercise, and adequate water intake are required. Failure to follow these recommendations may compromise the results of my sessions.


I understand that bodywork and massage are not substitutes for medical care or treatment by a licensed medical professional. The technician is not qualified to perform spinal or skeletal adjustments, diagnose conditions, prescribe medications, or treat physical or mental illnesses.


I affirm that I have informed my technician of all known medical conditions. I understand that neither the technician nor Center of Mind Body Spirit shall be held liable if I fail to disclose this information. I also understand that certain medical conditions may make massage or specific bodywork inappropriate, and a physician’s referral may be required prior to receiving services.


If I experience any pain or discomfort during a session, I agree to immediately inform the technician so that the treatment may be adjusted or discontinued. I understand that I may request to stop the session at any time for any reason. I will not hold the technician or Center of Mind Body Spirit responsible for any pain or discomfort experienced during or after the session.


Proper draping will always be used to the best of our ability during all bodywork and massage sessions. No breast massage will be performed without the written consent of both the client and the technician. If I request breast or body lift and/or enhancement services, I understand that the procedure is strictly clinical and non-personal in nature.


Any illicit, inappropriate, or sexually suggestive remarks or advances made by me will result in the immediate termination of the session. I understand that bodywork and massage are entirely therapeutic and non-sexual.

By signing this release, I acknowledge that I have read, understood, and agree to all of the above. I hereby waive and release the technician, owner, and Center of Mind Body Spirit from any and all liability—past, present, or future—related to bodywork and/or massage services.

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Prefer to fill it out by hand?
Download our printable PDF version.

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Instructions

1. Print the document clearly.
2. Sign the consent sections.
3. Bring it to your first appointment or scan and email to info@healthyliving.com

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