By checking here I further understand that massage or bodywork should not be construed as substitue for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which i am aware. I understand that massage/bodywork practioners 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.

Because massage/bodywork should not be performed under certain medical conditions, I affirm that i have stated all my known medical conditions and answered all questions honestly. I a gree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner's part should I fail to do so.

Give nthe above, I understand that response to treatment varies on an individual basis and that specific results are not guaranteed. Therefore, in consideration for any treateent received, I agree to unconditionally defend, hold harmless and release from any and all liability Even Flow Lymphatics and the individual that provided my treatment, the insured, and any additional insureds, as well as any officers, directors, or employees of the above companies for any condition or result, known or unknown, that may arise as a consequence of any treatment that I receive. 

I have fully disclosed on my client intake form any medications, previous complications, or current conditions that may affect my treatment. I understand and agree that any legal action of any kind related to any treatment I receive will be limited to binidng arbitration using a single arbitrator agreed to by both parties.

The client indicated below also agrees to forever hold harmless and release Even Flow Lymphatics from any and all liability, claims, or demands of any kind or nature related to the transmission of any disease, conditon or illness they may allege to have contracted or been exposed to as the result of any treatment, person, or visit at the insured's location. 

*Please note: Manual Lymphatic Drainage (MLD) is a very powerful modality and certain medical conditions are contraindicated and determine if and when you can receive a session. After the consultation and review of the information you have provided on this form, itwill be determined if MLD should be administered to you today. Some conditions will require a note from your doctor before proceeding. Please understand this is for your safety and well-being.