General & Medical Information
If you answer "yes" to any of the following questions, please explain as clearly as possible in the space provided.
Please take a moment to carefully read the following information you have provided and sign where indicated. If you have a specific
medical condition or specific symptoms, certain massage or esthetic treatments may be contraindicated. A referral from your
primary care provider may be required prior to services being rendered. If I experience any pain or discomfort during this session I
will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my comfort level. I also understand
that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will
be liable for payment of the scheduled appointment.