Take the next step on your healing journey
Take the next step on your healing journey

Massage & Bodywork Liability Waiver

  • I understand that Massage Therapy, Reflexology, Jin Shin Jyutsu, or any other energy healing techniques utilized by Kristian Googe and Vitality Wellness by Kris, LLC (“Vitality Wellness”) are provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow.

  • If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort.  I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.  Draping will be used during the session - only the area being worked on will be uncovered.

  • I understand that any services offered during sessions are not a substitute for medical care.  My therapist is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness.  

  • I affirm that I have notified my therapist of all known medical conditions and injuries.  I agree to inform my therapist of any changes in my health and medical condition.  I understand that there shall be no liability on the therapist's part should I forget to do so.

  • I understand that my client information and records are treated in a confidential manner, compliant with HIPAA.   

  • If I have added an Energy Healing component to my appointment (Anahata Code, Body Code, Emotion Code), I affirm that I have read and signed the Informed Consent for Energy Healing

  • Except in the case of gross negligence or malpractice, I and my representatives agree to fully release and hold harmless Kristian Googe and Vitality Wellness for and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session.

  • Clients under the age of 17 must be accompanied by a parent or legal guardian during the entire session.  Informed written consent must be provided by a parent or legal guardian for any client under the age of 17.
 
Informed Consent and Liability Waiver
Please sign this consent form and return it at the beginning of your scheduled session. If the appointment has been scheduled for a minor, a parent or legal guardian signature is required, and that parent or legal guardian must be present at the time of service.
Informed Consent Liability Waiver.pdf
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© Vitality Wellness by Kris, LLC | Terms & Conditions + Privacy Policy

Services provided, whether in person or by proxy, are not a substitute for medical care. Information provided on this website is not intended as medical advice and should not be used for medical diagnosis or treatment. Kristian makes no claims as to healing or recovery from any service and no guarantee is made towards validity. Information provided is not intended to create any physician-patient relationship, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.