BY SIGNING BELOW, YOU AGREE TO THE FOLLOWING:
I give my permission to receive massage therapy. I understand therapeutic massage is not a substitute for traditional medical treatment or medications and that the massage therapist does not diagnose illnesses and injuries or prescribe medications. And I have clearance from my physician to receive massage therapy.
I understand the risks associated with massage therapy (such as cupping, gua sha, Ashiatsu, hot stones, deep tissue, etc.) include, but are not limited to: superficial bruising, short-term muscle soreness, burns, & exacerbation of undiscovered injury. As well as any miscarriages, early labor, and other pregnancy complications from prenatal massage. I therefore release Vita Nova Massage and Antonietta Ramirez, LMT from all liability concerning these injuries that may occur during the massage session.
I understand the importance of informing my massage therapist of all medical conditions, allergies, and medications I am taking, and to let the massage therapist know about any changes to these. I understand there may be additional risks based on my physical condition.
I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the massage session, so she may adjust accordingly.
I understand that I or the massage therapist may terminate the session at any time. I understand that throughout the session, the therapist will always use a drape, meaning a blanket and sheet.
I also understand that my massage therapist does not massage genitals or perform perineal massage (massaging the tissues between the anus and genitals) and that any illicit or sexual innuendos or advances will result in termination of the session and that I am liable for full payment of the session. I also understand that my therapist does not date her clients and that I will not contact my massage therapist via text, phone, or email with conversation or questions regarding her personal life.
I understand that all communication between I the client and the therapist in any sessions, phone calls, texts, letters, or e-mails is confidential within the constraints of the law. This also applies to any session documentation and intake forms which will always be secured. I give permission for the therapist to contact my emergency contact(s) in case of an emergency.