BROWHOUSE - Body Sculpting Intake Form

I understand that the treatment I receive is provided for the basic purpose of improving the flow of my lymphatic system and also for relaxation. If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort.

I further understand that massage or bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which I am aware. I understand that massage/bodywork practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. 

This technique is a very powerful modality and certain medical conditions are contraindicated. 

Because massage/ bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I fail to do so. 

I understand the side effects associated with massage therapy include but are not limited to: fatigue/tiredness from toxins being released; tenderness around blocked lymph nodes; deep relaxation; sensations of being chilled/cold; superficial bruising; deeper and calmer sleep with more dreams; an increase of energy and vitality; increased thirst, urination, and/or bowel movement; nausea or brief dizziness when first getting off of the table.

I understand that massage is entirely therapeutic and non-sexual in nature.

By signing this release, I hereby waive and release my therapist from any and all liability, past, present, and future relating to massage therapy and bodywork.