GENERAL LIABILITY RELEASE FORM MASSAGE THERAPY SERVICES By signing below you agree to the following: 1) I give my permission to receive Therapeutic Massage Therapy and/or Chi Nei Tsang (abdominal massage). 2) I understand that therapeutic massage is not a substitute for traditional medical treatment or medications. 3) I understand that the massage therapist does not diagnose illnesses or injuries, or prescribe medications. 4) I have clearance from my physician to receive massage therapy. 5) I understand the risks associated with massage therapy include, but are not limited to: superficial bruising, short-term muscle soreness, exacerbation of undiscovered injury. I am informed that, as in all health care there may be very
slight risks to treatment, including, but not limited to, muscle strains and ligamentous sprains,
bruising, light-headedness/dizziness, tenderness, or even an exacerbation of the chief complaint
or symptoms for 24-28 hours. I therefore release the company, Vital Integrative Medicine LLC, and the individual massage therapist, from all liability concerning these injuries that may occur during the massage session. 6) I understand the importance of informing my massage therapist of all medical conditions and medications I am taking, and to let the massage therapist know about any changes to these. I understand that there may be additional risks based on my physical condition. 7) I understand that it is my responsibility to inform my massage therapist of any discomfort I may feel during the massage session so he/she may adjust accordingly. 8) I understand that I or the massage therapist may terminate the session at any time. 9) I have been given a chance to ask questions about the massage therapy session and my questions have been answered. *
