I have stated all conditions that I am aware of and this information is true and accurate to the best of my
knowledge. I will inform my health care provider and massage therapist if anything changes in my status. I
understand that massage/bodywork I receive is for the purpose of stress reduction, and relief from
muscular tension, spasm, or pain and to increase circulation. If I experience any pain or discomfort, I will
immediately inform my massage therapist so that the pressure and/or methods can be adjusted to comfort
level. I understand that my massage therapist does not diagnose illness or disease, nor perform any spinal
manipulations, and does not prescribe medications/treatments. I acknowledge that massage is not a
substitute for a medical examination or diagnosis, and that I should see my health care provider for those
services. If I am unable to attend my scheduled appointment, I will respect and abide by the set
cancellation policies. Sexual advances, request for sexual favors, and other verbal or physical conduct of a
sexual nature will constitute sexual harassment and will not be tolerated. I understand that I am receiving
massage therapy at my own risk. In the event that I become injured either directly or indirectly as a result,
in whole or in part, of the aforesaid massage therapy, I hereby hold harmless and indemnify the therapist,
their principals, and agents from all claims and liability whatsoever.