I hereby give consent to Massage Therapy Center of Sylvania and any of their
licensed massage therapists to perform therapeutic massage therapy with the
understanding that the results vary from each person and no specific results can
be guaranteed. I understand that a massage therapist is not qualified to
diagnose, treat or prescribe for any illness or disease.
I hereby state that the above information is completed to the best of my
knowledge and it is my responsibility to provide updated medial/physical
conditions. I waive and release Massage Therapy Center of Sylvania and my
licensed massage therapist from any/all liability or complications past, present
and future relating to massage therapy and bodywork. I also understand that
any inappropriate comments and/or behavior will result in termination of the
massage and full payment will be required.
Please be advised that all information is confidential and will not be released
without written consent from you. If you are unable to keep an appointment,
please give a 24 hour notice or as early as possible. Thank you for your time and choosing Massage Therapy Center of Sylvania!