Massage + sound healing consent form A collaboration between @iksre and @the_humble_nookName* First Last Address* Street Address Address Line 2 City ZIP / Postal Code Phone*Email* OccupationHow do you spend your day?* Seated Standing Reason for treatmentHave you ever experienced any of the following?* Broken bones Disc problems Muscle strain/sprain Nerve pain High/low blood pressure Heart condition Anxiety/Depression Varicose veins/blood clots Arthritis Sleep disorders Osteoporosis Numbness or tingling anywhere Autoimmune disease Any relevant detail we should know aboutAre you pregnant?* No Yes How many weeks?How did you hear about us? Friend Socials Google/Web By signing, I affirm that a licensed practioner has verified my good health and physical condition to receive a Remedial massage treatment. I hereby agree to irrevocably release and waive any claims that I have now or may have here after against The Humble Nook and all related facilities and premises for any personal injury or negligence. Those under 18 years of age must have this form signed by a parent or guardian.Signature*Date MM slash DD slash YYYY
