Name *
Name
Month/Day/Year
Preferred Means of Written Communication *
Medical Conditions *
Check any items that apply
Release *
understand that bodywork, massage and yoga therapy may be useful in maintaining wellness but that it does not take the place of a doctor's care. Any information received during a session is educational and is intended to bring awareness to my own health situation and is to be used at my own discretion. I understand that the practitioiner is not diagnosing or prescribing anything for my medical needs. I will remain in full control at all times and take full responsibility for my own well-being during the session. By checking this box, and agreeing to these terms, I agree not to hold the therapist liable for any adverse effects of any treatment administered. I understand that there is a cancellation policy and that I can be charged for the full price of a session if an appointment is cancelled or postponed with less than 24 hours notice.

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