Big Shoulders Chicago
New Client Health History & Waiver
For you safety, Massage Therapists must be aware of any history regarding any of the following conditions. Therapeutic massage may affect these conditions and your health. Please take a moment to check any of the following conditions that may apply and make any appropriate notes in the space below.
Please explain any of the above conditions in detail:
Cancellation Policy: Your appointment time is reserved especially for you. If you are unable to keep you appointment please contact us 24 hours in advance or you will be charged for the full value of your service.
Package Policy: All packages expire one year after date of issue. There are no transfers or refunds of packages.
Email Policy: By providing my email above I agree to receive occasional emails from Big Shoulders Chicago, LLC. I understand I may unsubscribe or change my email preferences at anytime.
I, the under signed, understand that massage therapy is for the purpose of stress reduction, relief from muscular tension, general relaxation and improvement of circulation. I also understand that the massage therapist does not diagnose any illness, disease, physical or mental disorders and; does not prescribe medical treatments or pharmaceuticals; nor do they perform any spinal manipulations. It has been made clear to me that massage therapy is not a substitute for medical treatment and that it is recommended that I see a physician for physical ailment I might have. I have stated all my known medical conditions and understand it is my responsibility to keep the massage therapist updated on any changes in my health so that they may make any appropriate adjustments to our sessions. By nature of the technique, I understand the increased risk of injury to my person when receiving Ashiatsu Oriental Bar Therapy. I understand that if I choose to receive deep tissue techniques during my massage therapy sessions that, as a result of these techniques, I put myself at risk for injuries. In addition, if I request a higher level of pressure then that of the therapeutic range that the therapist is providing I will be responsible for aggravating any condition that may already be present or incurring a new injury. With this in mind, I agree that the massage therapist, Big Shoulders Chicago, LLC and their agents, contractors, employees, representatives, executors, insurers, and all others acting on it's behalf will not be held liable for any and all claims or liabilities for injuries or damages to my person and/or property that may arise during or as a of result of this or any future massage therapy sessions.