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Chair Massage Release Form

First Name

Last Name

Phone

Are you experiencing pain or discomfort?

Yes

Do you have any medical conditions, injuries, or recent surgeries that we should be aware of?

Yes

Are you pregnant?

Yes

Expand on any yes answers

I understand that the chair massage I am about to receive is for relaxation and stress relief purposes only. It is not a substitute for medical treatment. I acknowledge that if I experience any pain or discomfort during the session, I will immediately inform the therapist so they can adjust the pressure or technique. I further understand that the therapist reserves the right to refuse or discontinue treatment if they deem it unsafe or inappropriate based on my health information. By signing below, I voluntarily agree to receive chair massage therapy and release Abby Chavez, Creative Wellness Massage, and its affiliates from any liability related to the massage treatment.

Thanks for submitting! Enjoy your massage.