I certify that I will be receiving on-site chair massage or facial services. I have discussed any issues that may be contraindicated for massage or facial services. I am receiving this on-site chair massage or facial services at my own will and assume full responsibility in doing so. I, nor any person representing my interest, will not seek damages should I fail to mention any condition, current or past, which may be considered contraindicated for massage or facial services. I further waive all rights to pursue any legal action concerning matters of this on-site chair massage or facial services. Providing your name on this form will confirm your acknowledgement of your consent to perform services and receive promotional emails. It is my choice to receive spa treatments, including massage, skin care, hair removal or microdermabrasion. Because massage/bodywork, skin care and other spa treatments should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, or answered all questions asked of me honestly. I understand that Estheticians and Massage Therapists do not diagnose illness, disease, or physical or mental disorders, nor do they prescribe medical treatments, pharmaceuticals, or perform spinal manipulations or skeletal adjustments and that nothing said in the course of the session given should be construed as such. I acknowledge that these treatments are not a substitute for medical examination or diagnosis, and that it is recommended I see a primary health care provider for that service. If I experience any pain or discomfort during the session, I will immediately inform the Massage Therapist or Esthetician so that the service may be adjusted to my level of comfort or discontinued. I could experience varying degrees of redness, burning, peeling, itching, etc., especially in the initial stages of a skin care program.
I hereby release the practitioners, Hand and Stone Massage and Facial Spa and their insurers, and their respective officers, directors, stockholders, successors, employees, franchisor, franchisees and agents from all liability of any nature whatsoever, whether past, present, or future, for injury or damage which may occur to myself or my family as a result of my receiving massage, skin care, facials, peels, microdermabrasion, nuface, nubody or hair removal services.
