Massage Therapy Consent & Release Form

Full Name

Email *

Phone *

Date Of Birth

Address

Street Address

City

State

Country

Postal code

CONSULTATION DETAILS:

1. Massage Type

Add-On Tools & Enhancements *

Add-On Tools & Enhancements

Consent-Initials:

Clear

I give full permission to Anny-M LLC and Licensed Therapist Kathleen Dumont to incorporate the selected tools and enhancements into my massage session. I understand all services are provided with care and according to professional standards, and I voluntarily consent to their use.

Any Specific Concerns or Goals for the Consultation?

3. Focus Areas

4. Areas to Avoid

MEDICAL HISTORY:

Current Medications *

Any Previous Cosmetic Procedures? *

Any Allergies?

Any Known Medical Conditions

ADDITIONAL INFO:

Any Additional Comments, Questions Or Special Requests?

6. Acknowledgment & Release of Liability *

7. Signature *

Clear

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.