CLIENT INFORMATION FORM
This form is required to be completed in entirety prior to your first visit. Thank you
Email *
Date *
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Full Name *
Preferred Name
Date of Birth *
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Age *
Mobile phone *
Email *
Address *
Occupation *
Emergency Contact - NAME *
Emergency Contact - MOBILE *
Emergency Contact - RELATIONSHIP TO YOU *

Please check (√) any conditions that apply to you:

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Required

Please indicate any areas of concern or specific areas you would like to focus on during the massage session: 

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Are you pregnant? *
If pregnant, how many weeks?

Have you had a professional massage before?

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If yes, when was your last massage?

Please indicate any allergies or sensitivities to oils, lotions, or other products: 

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Are you currently taking any medications?

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Please list medications:

Have you experienced any recent injuries or accidents?

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If yes, please list:

Is there any other information you believe the massage therapist should know? 

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I understand that the massage therapist is not a physician and that massage therapy is not a substitute for medical examination or diagnosis. 

I have stated all my known medical conditions and have answered all questions honestly. I will keep the massage therapist updated on any changes to my health.

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HARRIS BODY THERAPY WAIVER FORM:

Business Information
Business Name: Harris Body Therapy
Email: harrisbodytherapy@gmail.com
Website: www.harrisbodytherapy.org
Mobile: 0417 82 66 72

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CLIENT CONSENT AND AGREEMENT

I hereby acknowledge and agree to the following terms and conditions before receiving massage therapy services from Harris Body Therapy:

Description of Services:

The treatment therapy involves techniques applied to various body parts, including but not limited to the pelvic floor area, Tailbone and pubis bone, buttock cheeks, groin area containing lymphatic nodes, armpits, and breast tissue area containing lymphatic nodes. Face muscles, Eye muscles, the neck and throat, finger and toe manipulations (at client discretion)                                            
Treatment Details:

I understand that massage therapy may involve touching and manipulating muscles, tissues, and sensitive areas as indicated above. I acknowledge that I have been informed that the therapist may work near sensitive or intimate areas and have the option to decline any specific technique or area of treatment.

Clothing and Privacy:

I am aware that the therapy might require partial to full disrobing, with the option to remain in underpants only. I understand that my privacy and confidentiality will be respected throughout the session, and draping will be used to ensure modesty and comfort.

Assumption of Risk:

I acknowledge that the therapist has explained the treatment details, potential benefits, and risks associated with the treatment techniques. I voluntarily assume all risks related to the treatment therapy, including but not limited to discomfort, soreness, or emotional responses. For surgeries of any type (past and present) you are being treated at your peril and I take no responsibility for any risk. 

Confidentiality:

All information disclosed during the session will be kept confidential unless required by law.

Client Declaration:

I confirm that I am not opposed to nor offended by swearing during my treatment. as mentioned in the agreement. 

Client Consent:

By signing this waiver, I acknowledge that I have read and understood the above mentioned terms and conditions. I consent to receive massage therapy services
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DISCLAIMER NOTICE:


All communications, answers, comments and opinions provided by Harris Body Therapy are only general information from studies, experiences and knowledge gathered over the years of being educated by several health professionals, google and YouTube. It is also worth doing your research as there is more than enough professional information at your fingertips. I do not claim to heal anyone but merely share the functions and techniques to assist you in your ability to self-heal. This is not intended to be a substitute for informed professional medical, psychiatric, psychological, legal, or other professional advice. You should always speak with your doctor, General practitioner, physician, or another healthcare professional before taking any medication or nutritional, herbal, or homeopathic supplement, or adopting any natural treatment for a health problem. If you have or suspect that you have a medical problem, promptly contact your healthcare provider physician or another healthcare professional.  Information provided on this site and the use of any products or services advertised on this site DOES NOT create a doctor-patient relationship between you and any of the advisors or others affiliated with this site.

TAKE NOTICE THAT: by entering or registering on the website or clicking  I agree or I accept on the website it shall be taken that you hereby agree to the terms of this  DISCLAIMER NOTICE.

TAKE NOTICE THAT: Harris Body Therapy takes no responsibility for any unsafe practice. Harris Body Therapy DOES NOT intend to diagnose cure, prevent or treat any disease or illness. Harris Body Therapy makes no health claims.

TAKE NOTICE THAT: by entering or registering on the website or clicking agree or accept on this website, it shall be taken that you have read and understood this Notice and consent in full to the terms of this DISCLAIMER NOTICE and that all parties have full accord and satisfaction.

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