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Informed Consent & Waiver

1. I understand that massage body workers and holistic practitioners are not medical doctors and do not diagnose illness, disease, or any physical or mental disorder. I acknowledge that massage and alternative holistic therapies are not substitutes for medical treatment, and that Blue Sapphire Massage, “the company”, recommends I see a primary healthcare provider for that service. I understand that it is my responsibility to communicate with my therapist if I have health concerns or questions about my session. I do not have any injuries and/or conditions that would prevent me from receiving a massage, nor has a health care provider told me that I should not receive massage or alternative therapies.

2. I understand that massage therapy and bodywork services are a therapeutic health aid and are non-sexual. I understand my massage therapist reserves the right to end a therapy session in the case of sexual innuendo or advances from the client. I also understand that any illicit or sexually suggestive remarks and/or advances made by me will result in immediate termination of the massage, and I will be liable for full payment of the scheduled session.

3. Any information exchanged during a massage or bodywork session is confidential and is only used to provide me with the best heath care services available. I understand that a massage therapist will ask me questions about my health and physical condition and that I am obligated to answer truthfully and honestly about my health history in full detail.

4. I understand that my feedback is essential in my treatment, and that if I experience any unusual discomfort and/or pain during my massage session, it is my responsibility to inform the therapist in order to enable the therapist to adjust the pressure or technique being used.

5. The therapist reserves the rights to decline, discontinue, or restrict services based on provided information that may indicate that massage therapy would put my health or the therapist’s health at risk.

6. I acknowledge that I am responsible to be on time to my appointments and that the therapist is not under any obligation to extend my therapy session. I also agree that I am responsible to pay for the full time I have booked with the therapist if I am late. I understand my appointment time is reserved for me only. If I miss an appointment or am unable to give twenty-four (24) hours’ notice when I need to change or cancel my appointment, I agree to pay Blue Sapphire Massage in full for the booked appointment time. I further understand that I will additionally be charged $30.00 for any returned check.

7. I understand that massage therapy and bodywork are for the purposes of stress reduction, relief from muscular tension and spasm, general relaxation and improvement of circulation and energy flow.

8. I understand that the practitioner does not prescribe medical treatment of pharmaceuticals, nor does he/she perform any spinal manipulations.

9. I understand that the service offered today, and in the future, are not substitute for medical care and that any information provided to me by the therapist is purely for educational purposes and is not diagnostically prescriptive in nature.

10. I have stated all of my known medical conditions on the Client Intake form. I have consulted a medical doctor or licensed medical health care practitioner regarding any checked or described conditions.

11. I understand that is it solely my responsibility to keep the therapist updated on any changes in my physical health and I further understand that Blue Sapphire Massage and the therapist shall not be liable for any purpose and for any reason whatsoever, should I fail to inform the therapist
of any health changes.

12. I have reviewed this form in its entirety and I have discussed all my concerns regarding my treatment with my therapist.

Acknowledgement Section

Client:

By signing this “Informed Consent & Waiver”, I consent to receive therapy at Blue Sapphire Massage and hereby agree to all policies of Blue Sapphire Massage, and waive and release Blue Sapphire Massage and its entire staff, massage therapists, and bodywork practitioners from any and all past, present, and future liability, loss, cost, claim, or damage whatsoever which may be imposed upon the Company related to massage therapy & bodywork; including but not limited to reflexology, acupressure, polarity therapy, energy therapy, Reiki, nutritional therapies, all forms of kinesiology, aromatherapy, craniosacral therapy, myofascial release therapy, trigger point therapy, pregnancy massage, stretching therapy, strength and condition training, among others. I further undertake to indemnify and hold Blue Sapphire Massage harmless from any incident(s) arising from my use of Blue Sapphire Massage’s services.

Parent/Guardian Waiver for Minors:

If the client is less that 18 years old, the Client’s parent and natural guardian hereby represents that he/she is, in fact, acting in that capacity, has consented to his/her child or ward’s availing of the services of Blue Sapphire Massage, and has agreed individually and on behalf of the child or ward, to the terms of this “Informed Consent and Waiver”. The undersigned parent or guardian further agrees to save and hold harmless and indemnify Blue Sapphire Massage from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon Blue Sapphire Massage relating to massage therapy and bodywork; including but not limited to reflexology, acupressure, polarity therapy, energy therapy, Reiki, nutritional therapies, all forms of kinesiology, aromatherapy, craniosacral therapy, myofascial release therapy, trigger point therapy, pregnancy massage, stretching therapy, strength and condition training, among others, on behalf of the Client and all the Client’s parents or legal guardians.

 

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