I have completed this form to the best of my knowledge and will inform the massage therapist of any change in my physical health.

I understand that the massage I receive is provided for the basic purpose of relaxation, stress reduction and relief of muscular tension. If I experience any discomfort during this session, I will inform the practitioner so that the pressure may be adjusted to my level of comfort.

I understand that a massage therapist can not diagnose illness, disease, or any medical disorder. I am responsible for consulting a physician or physical therapist for any physical ailments I have.