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Guest Consent Form
Guest Consent Agreement
Please read and check the following statements pertaining to your requested massage session.
Then enter your name and confirm today's date before sending the agreement.
A copy of this agreement will be emailed to the email address you provided in the request form.
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I understand that the massage given to me by Nora L. Carter, LMT is for the purpose of stress reduction, pain reduction, relief from muscle tension, increasing circulation, and/or part of my requested session.
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I understand that the massage therapist does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage therapy.
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I understand that massage therapy is not a substitute for medical care and that it is recommended that I work with my primary caregiver for any condition I may have.
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I have stated all my known physical conditions and medications, and I will keep the massage therapist updated on any changes.
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I understand that this massage session is entirely therapeutic and non-sexual in nature.
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By submitting this release, I hereby waive and release my therapist from any and all liability, past, present, and future relating to massage therapy and bodywork.
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I have received this policy statement, and have read and agreed to the policies therein.
First Name
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Last Name
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Email
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Todays Date
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Date
Format: 12/23/2024
