Client Intake Form

Blank Form (#3)

Massage Informed Consent, Agreement and Liability Waiver

I understand that Thai Yoga Massage (TYM) is intended to promote relaxation, relieve muscle tension, increase range of motion, improve circulation, reduce stress, enhance energy flow and balance, and promote overall well-being and mobility.  I understand that massage is NOT a substitute for medical treatment, examination, or medications, and it is recommended to continue to work with my primary caregiver regarding any condition that I may have.  I have informed the massage therapist of all my known physical and medical conditions and medications, and I will keep her updated to any changes in my health status.  I am aware that heated herbal compresses may be used during a session, and I will inform the therapist of any heat sensitivities or allergies I may have.   I also understand that all information regarding my health history, records of my sessions, and other information related to the session will remain in strict confidence.   If a healthcare provider requests this information, I agree it will be released with my written consent.  By clicking the Submit Form, I consent to receive Thai Yoga Massage and agree to HOLD HARMLESS the massage therapist for this session and for ANY future sessions.