Massage Therapy Agreement

Disclosure Agreement

  • Please help us ensure a safe and comfortable massage experience by providing the following information. Check all that apply and explain below:

  • We are delighted you have chosen our massage services. The company only employs professional Massage Therapists. If requested, the clinic administrator will provide proof of your therapist's license/permit (where applicable). Additionally, if you have any questions, comments or complaints about your Massage Therapist, please bring it to the attention of the management immediately. Male and female genitalia and women's breasts will not be exposed or massaged at any time. Modest draping will be used during the session. If during the session you feel uncomfortable, simply ask your therapist to end the session.

    It is your responsibility to inform the therapist of any pre-existing conditions, limitations or specific sensitivities and to inform your therapist if you feel any discomfort during the session. If you do experience discomfort, please ask the therapist to adjust the level of pressure or heat. You understand and voluntarily accept any risks of which you have been advised about associated with your massage, or from any use of the company's facilities, and hereby release Massage by Heidi (including its employees, practitioners, agents, and insurers) from all liability for any injury, including, without limitation, personal, bodily or mental injury, economic loss or any damage to you resulting there from. You further hereby release all of the foregoing personnel and entities from all liability arising from any any such injury or damage resulting from your failure to disclose any pre-existing condition, limitation, specific sensitivities, or your failure to inform your therapist of any such injury or damage resulting from your failure to disclose any pre-existing condition, limitation, or specific sensitivities, or your failure to inform your therapist of any discomfort during the session. Your therapist may determine that it is unsafe for you to proceed with or continue a therapeutic session due to health concerns. In this event you may be required to provide Massage by Heidi with a physician's medical release prior to continuing treatment.

    The undersigned acknowledges that he/she has read this agreement.