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Pre-Partum Massage Consent Form 

Form

I verify that I am not having a high risk pregnancy and I have stated all my known medical conditions. I understand that I will be receiving massage therapy for stress reduction, muscle relief, or improving circulation and energy flow. I understand that the massage therapist does not diagnose illnesses. As such, she also does not prescribe medical treatment or medications. I also understand that she does not perform spinal manipulations. I am aware that this massage is not a substitute for medical examination or diagnosis, and that it is recommended that I see a physician for any ailment that I might have. I understand and agree that I am receiving massage therapy entirely at my own risk. In the event that I become injured either directly or indirectly as a result, in whole or in part, of the aforesaid massage therapy I HEREBY INDEMNIFY the therapist, her principals, and agents from all claims and liability whatsoever.

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Confidentiality Note: The information provided in the Pre Partum massage consent form is for the sole purpose of carrying out safe and effective treatment(s) and will be kept strictly confidential.