Mirembe Massage Therapy Client Agreement
Please take a moment to read and initial all of the following statements, then fill out the information below. Your initials indicate that you agree with each of these statement. If you prefer, you can download, print, and bring the downloadable form to your appointment. This is available at mirembe.massageplanet.com
If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.
I understand that the services offered today are not a substitute for medical care. I understand that my therapist is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat
physical or mental illness.
I affirm that I have notified my therapist of all known medical conditions and injuries. I agree to inform the therapist of any changes in my health and medical condition. I understand that there shall be no liability on the therapist’s part should I forget to do so.
I understand that massage is entirely therapeutic and non-sexual in nature. Sexual advances of any kind will not be tolerated.
I understand that, for security and safety, one of the therapist's assistants is given the following information on each appointment: Location and appointment times. The assistants are contacted prior and after each appointment.
By signing this release, I hereby waive and release my therapist from any and all liability, past, present, and future relating to massage therapy and bodywork.
The therapist ensures that clients will be modestly and appropriately draped at all times.
Payment is required at the time servies are rendered, or before.
I have read, understand, and agree to abide by all of the above statements.
I understand that the massage therapy given here is only for the purpose of stress reduction, or relief from muscular tension.
It has been made very clear to me that this massage is not a substitute for medical examination and/ or diagnosis.
Because the massage therapist must be aware of existing physical condition, I have stated all my known medical conditions and take it upon myself to keep the massage therapist updated on my physical health.
BY TYPING MY NAME BELOW, I INDICATE MY AGREEMENT WITH THE ABOVE STATEMENTS. I AFFIRM THAT THIS WAS FILLED OUT BY MYSELF AND I ACCEPT THE FOLLOWING AS MY SIGNATURE.
Do Not Fill This Out