Therapy Client Liability Form


By signing you agree to the following:


1. I give permission to receive Foot reflexology, Indian Head Massage, Face Reflexology, Reiki, ThetaHealing, Therapeutic Touch and Emotion Code Treatments.
2. If I experience pain or discomfort in the session, I will immediately inform the therapist so that pressure/strokes are adjusted to my comfort level. (Foot and Facial Reflexology and Indian Head Massage). I will not hold my therapist responsible for any pain or discomfort experience during or after session.
3. I understand that Foot Reflexology, Facial Reflexology, Indian Head Massage, Therapeutic Touch and Reiki, ThetaHealing and Emotion Code is not a substitute for medical care.
4. I affirm that I have notified my therapist of all known medical conditions and injuries.
5. I agree to inform therapist of all changes in my health or medical condition and medications.
6. I have clearance from my physician for Foot Reflexology, Facial Reflexology, Indian Head Massage, Therapeutic Touch, Reiki, ThetaHealing and Emotion Code.
7. I understand I have the right to ask questions about the Foot reflexology, Indian Head Massage, Face Reflexology, Reiki, Therapeutic Touch, Theta Healing and Emotion Code Treatments.
8. I understand I or therapist may stop the session at any time.
9. I understand risk factor associated with Foot Reflexology, Facial Reflexology, Indian Head Massage, Therapeutic Touch, TheataHealing and Emotion Code included, but no limited to: muscle soreness, sensitivity, headaches, etc. and elimination of toxins.

If having problems with the form you can download here.

Release Form

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