Massage Form

First Name *
Last Name *

Date of Birth
Occupation

Address

Street Address
Line 2

Postcode

Date of last visit to GP
Please list any surgeries
Please list any orthopaedic injuries

If yes, what makes it better?
If yes, what makes it worse?

Please outline details of any of the above if applicable

I confirm that I have also received a COVID-19 Consent form and have completed honestly to the best of my knowledge.* (sent separately via email)
 
I understand by submitting this form I accept the following terms and conditions and agree for Auraflow to contact me.*
 
Today's Date

1) I give my permission to receive massage services.
2) I understand that therapeutic massage is not a substitute for traditional medical treatment or medications.
3) I understand that Auraflow Fitness and Therapies does not diagnose illnesses or injuries, or prescribe medications.
4) I have clearance from my Doctor to receive massage therapy.
5) I understand the risks associated with massage therapy include, but are not limited to:
• Superficial bruising or redness
• Short-term muscle soreness
• Exacerbation of undiscovered injury
I, therefore, release Auraflow Fitness and Therapies from all liability concerning these injuries that may occur during the massage session.
6) I understand the importance of informing Auraflow Fitness and Therapies of all medical conditions and medications I am taking and to let Auraflow Fitness and Therapies know about any changes to these. I understand that there may be additional risks based on my physical condition.
7) I understand that it is my responsibility to inform Auraflow Fitness and Therapies of any discomfort I may feel during the session so she may adjust
accordingly.
8) I understand that I or Auraflow Fitness and Therapies may terminate the session at any time.
9) I have been given a chance to ask questions about the session and my questions have been answered.