Massage Waiver
I. Introduction
Welcome to [YOUR COMPANY NAME] Before beginning your massage therapy session, we require all clients to complete this Waiver Form. This document outlines the risks involved and relinquishes certain legal rights in the event of an injury or complication. Your safety and well-being are our priorities, and understanding this agreement is essential to proceed with our service.
II. Client Information
Please provide your personal details:
Name: [YOUR FULL NAME]
Date of Birth: [YOUR DATE OF BIRTH]
Contact Number: [YOUR CONTACT NUMBER]
Email Address: [YOUR EMAIL ADDRESS]
III. Health Status
In the interest of your health and to customize your experience:
Do you have any allergies, especially to oils or lotions? [YES/NO]
Are you currently experiencing any injuries, surgeries, or chronic pain? [YES/NO, DETAILS]
Please list any medical conditions that may affect your therapy session: [LIST CONDITIONS]
IV. Acknowledgment of Risk
Massage therapy involves physical manipulation which may cause unforeseen complications. By signing below, you acknowledge and understand that while the risks are minimal, the potential for adverse reactions exists, including muscle soreness and bruising.
V. Waiver of Liability
By agreeing to proceed with the massage therapy provided by [YOUR COMPANY NAME], you agree to release, waive, discharge, and covenant not to sue [YOUR COMPANY NAME], its officers, therapists, and other employees from any liability from any and all claims resulting from any accidents, injuries, or damages you may experience during or as a result of the massage.
VI. Consent to Treatment
I, [YOUR FULL NAME], voluntarily request and consent to receive massage therapy and understand that there is no obligation to treat. I have accurately reported all physical conditions, allergies, and medications and have not omitted any relevant information. I understand my treatment may be stopped at any time by either myself or my therapist should it be deemed necessary.
VII. Opportunity for Questions
You have the opportunity to discuss any aspect of your massage therapy with [THERAPIST'S NAME]. Please ask questions if you do not understand any part of this consent form or the massage procedures.
VIII. Client Signature
By signing below, you confirm that you have thoroughly read and understood the above conditions and agree to abide by them. Your signature also indicates full consent to the treatments discussed and the information provided.
[CLIENT NAME]
[Date]
IX. Acceptance by Massage Provider
[YOUR COMPANY NAME] hereby acknowledges the acceptance of this waiver.
[AUTHORIZED NAME]
[DATE]
Waiver Templates @ Template.net
