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1Massage @ aTime, LLC

Waiver

I acknowledge, that all therapy services, beauty treatments, natural and organic skin care, and the practice of therapeutic massage, including, but not limited to, hot stones, and ice therapy, Ultrasound Therapy, Radio Frequency devices, and various other beauty procedures is not an exact science, and no specific guaranties can or have been made concerning the outcome. Every “BODY'' is different and will not be the same from person to person. Please keep in mind that there are a lot of factors to consider and personal responsibilities that can affect the process.

I understand that some clients experience more change and improvement than others. In virtually all cases, multiple treatments are required to realize a difference.

I also understand and agree to assume the following risks and hazards which may occur in connection with any treatment including but not limited to unsatisfactory results, soreness, poor healing, discomfort, redness, blistering, nerve damage, scarring, infection, change in skin pigmentation, allergic reaction, muscle damage, and increased hair growth. I understand that even though precautions may be taken in my treatment, not all risks can be known in advance.

Given the above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treatment received, I agree to unconditionally defend, hold harmless and release from any and all liability 1 Massage @ aTime LLC, Sharon Sterling and the individual that provided my treatment, the insured, and any additional insureds, as well as any officers, directors, or employees of 1 Massage @ aTime LLC and/or companies for any condition or result, known or unknown, that may arise as a consequence of any treatment that I receive.

I have fully disclosed, on my client intake form, any and all medications, previous complications, or current conditions that may affect my treatment. I understand and agree that any legal action of any kind related to any treatment now and future appointments that I receive, will be limited to binding arbitration using a single arbitrator agreed to by both parties.

The client indicated below also agrees to forever hold harmless and release from any, and all liability, claims, or demands of any kind or nature related to the transmission of any disease, condition, or illness they may allege to have contracted or been exposed to as the result of any treatment, person, or visit at the insured's location.

Do you have any medical history issues, or have done any invasive treatment in less than 14 days, take any medication, or allergy?

Yes

No

I affirm that I have notified my therapist of all known medical conditions and injuries and that I will notify my therapist of any changes in my health and medical condition.

I understand that massage is entirely therapeutic and non-sexual in nature.

If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort.

I understand that the services offered today are not a substitute for medical care. I understand that my therapist is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness.

Because Manual Lymphatic Drainage (MLD) should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly.

I understand that should I cancel an appointments less than 24 hours before the scheduled time or “No Show without notification “I am obligated to pay for the full-service cost and that all future reservations require a deposit or full payment”

I have read and understood the above. This submission is acknowledgment that I agree to the information above. It is important to your therapist who will review all information provided to offer the best care possible.

Thanks for submitting!

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1 Massage at a time LLC

WELLNESS FOR LIFE

337-302-0877 Office Line

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