Krystal ChristensenSouth Jordan, UT

801.669.2993

I, ______________________(Client’s name), understand that massage therapy provided by therapist, Krystal Christensen is intended to encourage relaxation of the body and mind, reduce muscular pain and tension, increase range of motion, improve circulation, and promote general well-being through manipulation of the soft tissues of the body.

The benefits of massage as a therapy, possible contraindications, and treatment procedures have been explained to me. I understand that massage therapy is not a substitute for medical treatment and/or prescribed medications, and that it is recommended that I work concurrently with my primary care physician for any health conditions I may have. I understand that it is not within the scope of practice of my massage therapist to diagnose illness or disease, prescribe medications, or perform spinal manipulations. Any recommended practices from the therapist, (including but not limited to: various stretches, dietary changes/increased water intake, self-massage, etc.) are given as recommendations only and are to be performed at the client’s own discretion and risk.

I have informed the massage therapist of all my known physical conditions, (past and current), medical treatments, medications, and any other contraindications for massage. It is my responsibility to keep the massage therapist informed on any changes that occur regarding the aforementioned items. I understand that there shall be no liability on the practitioner's part due to my neglecting to relay pertinent health information.

Further, if I experience any pain or discomfort during the session, I understand that I must immediately communicate that to the therapist so that treatment can be adjusted.

I have received a copy of the therapist’s policies; I understand them and agree to abide by them.

_______________________________________ _________________Client’s Name (Print) Date

_______________________________________ Client’s Signature