I understand this consent form and have answered each question truthfully. I understand that the massage/bodywork I receive by the Shangri-La Springs massage therapist is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during this massage session, I will immediately inform the therapist so that the pressure and / or strokes may be adjusted to my level of comfort. I further understand that the massage or bodywork should not be construed as being a substitute for a medical examination, diagnosis or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any physical or mental ailment that I am aware of. I understand that the massage therapists 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 should be construed as such. I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapists part should I fail to do so. I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session. I also understand that the Licensed Massage Therapist reserves the right to refuse to perform massage/bodywork on anyone whom he/she deems to have a condition for which massage is contraindicated.
By signing below, Client or the Responsible Party (if applicable) expressly acknowledges he/she has carefully reviewed the following and desires to proceed with receiving services upon said careful review:
Contact with people increases the risk of infection from COVID-19. I am fully aware of the risks involved and give unconditional consent to receive services from this practitioner.
I consent to my name and contact information being shared with the state and/or federal health officials, in order to assist with contact tracing requirements of COVID-19 regulations. Disclosure requirements vary, but information shall only be released if certain governmental criteria are met.
I understand and acknowledge that neither my massage therapist, the staff nor Shangri-La Springs are able to completely control the spread of COVID-19 and I have chosen to enter this facility with the understanding that the services I shall receive are not conducive to social distancing.
My therapist, the staff, Shangri-La Springs and it agents, employees, affiliates and parent companies shall not be liable for any exposure to COVID-19 while at this location. I am fully proceeding at my own risk.