Aneurysms

Deep Vein Thrombosis

Heart Attack

High Blood Pressure

Eczema

Oral Herpes

Other Herpes

Psoriasis

Seizures

Stroke

Coeliac Disease

Hernia

Parasitic Disease

Ulcers

By checking this box I agree that I have listed all medical conditions to the best of my knowledge. If found that I have misrepresented any health conditions which leads to a complication I agree to hold myself, not Transcendence Massage & Yoga LLC, liable.*

By checking this box I agree that I understand that the massage I receive is provided for the basic purpose of relieving muscular tension, relieving pain and facilitating range of motion and relaxation. If I experience any pain or discomfort during the session, I will immediately inform the therapist so that the pressure and/or strokes may be adjusted to my level of comfort.*

By checking this box I agree that I understand that massage should not be construed as a substitute for medical examination, diagnosis, or treatment. I understand that massage therapists are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such.*

By signing this form I confirm my consent to treatment. In addition, I intend this consent to cover the treatment discussed with me and such additional treatment as performed by my massage therapist from time to time to deal with my physical condition for which I have sought massage therapy. I understand that at any time I may withdraw my consent and massage therapy will be stopped.*