Today's date: February 23, 2020
CONSENT FOR TREATMENT: If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the pressure and/strokes may be adjusted to my level of comfort. I further understand that massage should not be construed as substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or other qualified medical specialists for any mental; or physical ailment that I am aware of. I understand that massage practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be as such. Because massage should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the therapist's part should I fail to do so.This facility reserves the right to refuse services at their discretion based upon the patient conditions, practitioners skill set, patient attitude or action, without explanation or prior notice, and I agree to this policy.