Massage Form

Address

Street Address
Line 2

Postcode

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

Please outline details of any of the above if applicable

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.