Signature*
By checking the box below:
I certify that the information I have provided is true and complete.
I understand that the information I have provided on this form is confidential and will not be released without my consent.
I understand that 24 hours notice is required to reschedule an appointment; otherwise, the full cost of the treatment will be charged.
I agree to receive massage therapy care from the Kicking Lotus massage therapist.
I declare that I have disclosed any physical condition or other condition that may be incompatible with the care I am about to receive.
As an essential condition for the massage therapy care that I will receive, I agree to hold harmless the massage therapist for any damages or losses that may be caused to me in the context of or as a result of the care provided. To this effect, I waive any claims past, present or future originating from the care received. I thus release the massage therapist and any other third parties with whom they may be affiliated from any liability of any nature whatsoever in connection with the care received.
In doing so, the massage therapist commits to providing quality care and respecting the public health authorities' sanitary standards applicable to therapeutic care.
