Intake Form

LaVida Massage will not be held liable for any injury or condition that arises from application of massage despite completion of this form. The form is intended as an assessment tool only and serves as a guide for application of massage. I have stated all conditions that I am aware of and this information is true and accurate to the best of my knowledge. I agree to inform my massage therapist immediately of any change in the conditions stated above. I acknowledge that this information is confidential and intended for review by massage therapists, that a medical referral may be requested of me, and that LaVida Massage is not liable for the management of any condition. I also understand that any illicit or sexually suggestive remarks or advances made by myself will result in immediate termination of the session, and that I will be liable for full payment of the session. I also understand that once services are rendered, refund for dissatisfaction will not be given. Refund will only be given if my service is not completed. If you are satisfied with the service provided the minimum gratuity is $10 for a 60min and $15 for a 90min session.