By signing this waiver, I agree to the above terms and conditions.

Name

First Name

Last Name

Waver Questionnaire

I understand that massage therapy is provided for the purposes of stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow.

I will immediately inform my therapist if I experience any pain or discomfort during the session so pressure or techniques can be adjusted to my comfort level. I agree not to hold my therapist responsible for any discomfort experienced during or after the session.

I understand that massage therapy is not a substitute for medical care, and that my therapist is not qualified to diagnose, prescribe, treat, or perform spinal/skeletal adjustments.

I confirm that I have disclosed all known medical conditions, injuries, and physical limitations to my therapist.

I agree to notify my therapist of any changes in my health status in the future. I understand my therapist is not liable if I fail to share relevant health updates.

I understand that massage therapy at TC5 Kinetic Therapy is entirely therapeutic and non-sexual in nature.

I hereby waive, release, and discharge my therapist and TC5 Kinetic Therapy from any and all liability, past, present, and future, in connection with any massage or bodywork session I receive.

I am under the age of 18 and understand that my parent or legal guardian must provide written consent for me to receive massage therapy services. I will have my legal guardian sign this form on my behalf.

I am the parent or legal guardian of the minor receiving massage therapy. I give my informed consent for treatment and agree to the terms outlined above.

I have received, read, and agree to the TC5 Kinetic Therapy Policy Statement.