Client Form 6 – Massage Intake and Consent Form

Client Information

Full Name(Required)

Date of Birth(Required)

Phone Number(Required)

Email Address(Required)

Emergency Contact Information

Full Name(Required)

Relationship(Required)

Phone Number(Required)

Consent for Services

I understand that massage therapy is a therapeutic health aid and is non-sexual. Any sexual misconduct by the client will result in immediate termination of the session, and the client will be liable for payment of the scheduled appointment.

I acknowledge that massage therapy can cause muscle soreness and tenderness, and I should communicate any discomfort or pain to the therapist immediately. I also understand that certain medical conditions and medications may contraindicate massage therapy, and it is my responsibility to inform the therapist of any changes in my health status.

I understand that massage therapy is not a substitute for medical treatment or medications and that it is recommended that I concurrently work with my primary caregiver for any condition I may have. I have informed the therapist of all my known physical conditions and medications and will keep the therapist updated on any changes.

Release of Liability:

I release Jardin Secret Spa/Wellness Center, its staff, and the massage therapist from any liability for any injuries or adverse effects resulting from my massage session. I understand that Jardin Secret Spa/Wellness Center maintains a drug-free workplace and that any inappropriate behavior will result in termination of the session.

Consent and Acknowledgment:

By signing below, I acknowledge that I have read and understood the terms and conditions outlined above. I voluntarily consent to receive massage therapy services provided by Jardin Secret Spa/Wellness Center.

Client eSignature(Required)

Date(Required)

Parent/Guardian Signature (if under 18):

Date

Jardin Secret Spa/Wellness Center

Client Information

Emergency Contact Information

Health Information

Massage Preferences