Massage Liability and Informed Consent

  1. I understand I must inform the therapist if I experience any pain or discomfort and I can ask for the pressure to be adjusted.

  2. I understand Massage Therapy should NOT be construed as a substitute for medical examination/diagnosis/ or treatment and that I should see a physician/ chiropractor or other qualifies medical specialist for any mental or physical ailment I am aware of.

  3. I understand and agree Massage should not be performed under certain medical conditions and I affirm that I have stated all my known conditions and have answered all questions honestly.

  4. I have cited all conditions, and circumstances regarding my health history, medications, and past reactions to products or techniques.

  5. I will keep the therapist updated as to any changes in my medical profile and understand that shall be no liability to the business or therapist should I fail to disclose or update my health information.

Modality Release & Contraindications

Cupping

  1. I understand there is a possibility of discolorations that can occur from the suction of the Cup(s) this is a common reaction some people get and some don't.

  2. I understand that the discoloration is not a bruise and will dissipate from a few hours to as long as 2 weeks in some cases and in relation to my after-care activities.

  3. I understand that Cupping Therapy should not be combined with aggressive exfoliation/ 4 hours after shaving/after sunburn.

  4. I understand it is best practice to avoid drinking excessive caffeine or to consume alcohol after receiving Cupping Therapy.

  5. I understand the first time I experience Cupping Therapy my body may temporarily react to this as it might to the flu - producing flu-like effects like nausea/headache/or aches that will subside with rest and drinking water.

Heat Therapy, Hot Stone Massage and other Heat Related Tools (Hot Towels, Thermal Body Wraps and Hot Herbal Poultice)

  1. Contraindications to receiving Hot Stone Massage (including but not limited to): Heat Sensitive Conditions and/or Medications (such as Tachycardia), Autoimmune Dysfunctions, Epilepsy (increase of body temperature may trigger), Neuropathy, Heart Disease, Skin Conditions, Recent Surgeries, Pregnancy.

Contraindication to CBD topical application during Massage Therapy

  1. (Including but not limited to): Skin sensitivity due to what it may be mixed with (Camphor/Menthol/ Essential Oils: Tea Tree /Mint/Lavender/Etc.)

  2. I understand there are no psychoactive effects to topical CBD

Sound Bath, Sound Healing, Individual Sessions and Group Classes

Sound healing is a supportive, non-invasive practice that uses vibration and frequency to help the body relax and restore balance. It is not a substitute for medical or mental health care.

Please consult your doctor before participating if you:

  1. Have a pacemaker or metal implants

  2. Are pregnant

  3. Had a recent concussion

  4. Are managing a serious physical or mental health condition

By participating, I understand:

  1. My practitioner is not a licensed medical or mental health provider and does not diagnose, treat, or prescribe. As well as sound healing is a complementary practice and not a substitute for medical care.

  2. No medical claims are made or outcomes are guaranteed.

  3. I take full responsibility for my health and well-being during and after the session.

  4. I have disclosed relevant health concerns and will communicate anything that may affect my session.

  5. I consent to receive sound healing as supportive wellness care and release the practitioner from any liability related to this service.

  6. I release the practitioner from any liability arising from participation.

COMPLETE MODALITY RELEASE FORM

  1. Checking the box/agreeing to this form does not automatically mean you are agreeing to every service or modality offered. You will always have the choice to decide whether certain tools, including but not limited to, cupping, scraping, hot stones, etc. are used during your session. However, if you choose to include them, this form provides informed consent for their use.

  2. I understand and it has been explained to me the benefits and certain contraindications from receiving Cupping Therapy/ Scraping Technique/ Hot Stone Therapy and other Heat Focused Treatment/ Light Therapy and CBD creams/lotions/and balms and Sound Baths in a private or group setting.

  3. I understand this form is for the purpose of determining medical eligibility for my safety and written consent prior to verbal consent should I choose to have these modalities or instruments used after discussion with my Massage Therapist.