Thank You for Your Interest in a Free Chair Massage!

Name *

First Name

Last Name

Phone

(###)

###

####

Are you currently under the care of a medical professional for any condition related to your muscles, joints, or spine? *

Yes

No

Have you received professional massage therapy before?

Yes

No

Liability Waiver

I understand that massage therapy is a therapeutic, non-invasive, and non-diagnostic service intended to promote relaxation and relief of tension. I acknowledge that massage therapists do not diagnose illness, disease, or physical or mental disorders, and that massage is not a substitute for medical treatment. I affirm that I have disclosed all relevant health conditions and agree to inform the therapist of any changes. I release the massage therapist and Healing Solutions Inc. from any liability for injuries or conditions that may result from the massage session, except in cases of proven negligence. By submitting this form, I voluntarily agree to receive chair massage services and accept full responsibility for my participation.

Agree