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Chair Massage Waiver

Please fill out the following form
in order to receive a massage.

Do you or anyone in your home have any symptoms of COVID-19?
Are you suffering from a medical condition, illness, or injury that prevents you from getting a massage?
1. Do you or anyone you know suffer from a health condition that causes chronic pain?
2. If yes, would you like to refer them to get a free massage?
4. Would you like to receive a massage in the comfort of your home in the future?
5. Would you like to learn how to get a free massage when you join our VIP team?

By signing below, you agree to the following:


1)  You are physically capable of getting on and off the massage chair safely.

2)  You do not have any injuries or conditions that should prevent you from receiving massage therapy and have not been told by a physician that you should not receive massage therapy.

3)  You understand that massage therapy is not a substitute for medical care.

4)  You will be truthful with your therapist about all medical conditions you may have.

5)  You will report any discomfort or pain to your therapist during the massage.

6)  You understand that massage is for relaxation and therapeutic purposes only.

7)  You understand that any inappropriate behavior will result in refusal of service.

8)  You release your therapist and the associated business from all liability concerning any injury or damages that may occur during or after your massage.

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