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Consent Form

Please fill out the following form, 24 hours prior to your treatment. (please complete, after you made a booking)

Date of birth
Day
Month
Year
Do you have any spinal issues (e.g., herniated disc, lumbago)?
No
Yes

If the answer is YES, the use of the massage bed’s back roller function is not recommended. It can only be used at the client’s own risk, and they must sign a liability waiver before treatment.

Are you pregnant?
No
Yes

If the answer is YES, the use of the massage bed is not recommended during pregnancy. Also please consider we have longer treatments which could be uncomfortable during pregnancy. It can only be used at the client’s own risk after signing the liability waiver.

Do you have any allergies?
No
Yes
Are your ears sensitive?
No
Yes
Do you have any skin conditions?
No
Yes
Have you ever had an epileptic seizure?
No
Yes
Do you have a pacemaker?
No
Yes
Have you ever experienced a panic attack?
No
Yes
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