Name *

First Name

Last Name

Have you received Thai Bodywork before?

Yes

No

I agree that Thai Bodywork is for the purpose of relaxation, relief of muscular tension, increased range of motion and overall well being. If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that the pressure may be adjusted to my level of comfort. I further understand that massage or bodywork should not be construed as a substitute for medical examination, diagnosis, or treatment.I assume full responsibility for receipt of massage therapy; I release and discharge the practitioner from any and all claims, liability, damages, actions or causes of actions arising from therapy received. *

I agree.

I do not agree.