Waiver | RadiantBody

Massage Therapy Intake Form

Please take a moment to fill out the form.

Full Name

Phone

Emergency Contact

What brought you in today? What is your main goal?

How did you hear about me? ( referral, google, instagram or yelp? )

Are you currently under medical supervision for an acute or chronic condition? Previous or Current injuries or surgeries? Please explain if so:

By Checking this I Agree to these Terms :: I, understand that the massage I receive is provided for the purpose of relaxation and relief of muscular tension. I understand that it is my responsibility to listen to my body, and so if I experience any pain or discomfort during this massage session I will immediately come out of the position or movement and/or inform the therapist so that the pressure and/or strokes may be adjusted. I agree to keep the therapist updated as to any concerns of prior sensitivities or health conditions that may create any discomfort during the session so there shall be no liability on the therapist’s part should I fail to do so. I also understand that Amanda reserves the right to refuse to perform massages on anyone at any time. I also agree to the cancellation policy of 40% of fee if cancelled within 48 hours of the scheduled appointment. I agree to all that is stated above for all sessions that I receive with Amanda Joan Kellman. I Digitally Agree to not hold Amanda Kellman liable for the following :: Bruises from cupping. Any adverse reactions to Ozone Therapy, as I agree to this being a demo/self application

Thanks for submitting!

Radiant Body

Massage Therapy Intake Form