Massage Services Liability Waiver

Release of Liability Waiver for Massage Services


Client History

1. Have you undergone any surgery in the last nine months? *
2. Do you have, or are you recovering from any serious injuries?
3. Do you have any of these health conditions in the past or present?
4. Do you exercise regularly?
5. Are you pregnant or trying?


1. Do you have any allergies to lotions, oils or nuts?
2. Do you have any other allergies?


Massage Preferences

1. What type of massage do you prefer?
3. What type of massage lotion do you prefer?
4. Are you sensitive to warm therapeutic towels and warm lotion?


I confirm to the best of my knowledge, that the answers I have given are correct and that I have not withheld any information that may be relevant to my treatment. All information on this form will be kept strictly confidential. I agree to hold Spa Escape, and its employees harmless for any and all side effects, which may result from my informed decision to receive a massage treatment. I have read and understand the above release of liability waiver and hereby give my consent to receive a massage treatment.