Disclaimer: I agree that I will not hold blvd spa and its employees liable for any injury or condition that arises from application of massage despite completion of this form. This form is intended as an assessment tool only and serves as a guide for the application of massage not for medical treatment or medical assessment. If I experience pain or discomfort during the session, I will immediately inform the therapist so that the pressure may be adjusted. I understand that Massage Therapists are not qualified to perform spinal or skeletal adjustments, diagnosis, prescribe or treat any physical illness, and that nothing in the course of the session given should be construed as such. Draping will be used during this session. Only the body area being worked on will be uncovered. Clients under the age of 18 must have a parent or legal guardian present to provide a signature for authorization for the therapeutic massage session and must be with the same gender massage therapist.
I have stated all conditions that I am aware of and this information I provided is true and accurate to the best of my knowledge. I agree to inform my massage therapists immediately of any change in the conditions stated above on every visit moving forward. This consent form will stay on file and be used for this service and all future massage sessions. I acknowledge that this information is confidential and intended for review by massage therapists; that a medical referral may be requested of me; and that blvd spa is not liable for the management of any condition. I also understand that any illicit or sexually suggestive remarks or advances made by myself will result in immediate termination of this session, and I will be liable for full payment of the appointment