Level Up Massage Therapy — Massage Therapy Intake & Waiver (Boise, Idaho)

First name

Last name

Email

Phone

Birthday

Month

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Address

Health Information (check all that apply)

Please list any medical conditions, injuries, surgeries, pregnancy status, allergies/sensitivities, medications, or anything else your therapist should know.

Massage Preferences

Areas to focus on

Areas to avoid

Consent & Waiver

I understand massage therapy is not medical diagnosis/treatment and I should seek medical care when needed.

I confirm I disclosed relevant health conditions and will update changes.

I understand cupping/gua sha may cause temporary marks/redness/bruising/soreness/irritation and I consent when selected.

I understand there are risks (soreness, bruising, lightheadedness, irritation) and I assume them.

I understand massage is therapeutic/non-sexual; inappropriate behavior ends the session and full payment is due.

I understand the no call/no show policy: 100% charge.

I release Level Up Massage Therapy from liability except gross negligence/willful misconduct.

I consent to receive massage therapy services.

Signature

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Minor Guardian Consent

Signature

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Guardians full name

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