Indemnity Form - The Indigo Spa

Consent Form for Spa Treatments

THIS FORM MUST BE COMPLETED & SIGNED BEFORE COMMENCING TREATMENTS.

Please enable JavaScript in your browser to complete this form.

Layout

Name and Surname

Birthday

Contact Number

How did you hear about us

General & Medical Information

Any Surgery in the past five years? Explain below.

Accident or suffered any injuries in the past 2 years? Broken bones, etc. Explain below.

Terms and Conditions

I understand that the massage I receive is provided for the basic purpose of relaxation and relief of muscular tension. 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. I further 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 during the course of the session given should be construed as such. Because massage should not performed under certain medical conditions, I affirm that I have stated all my known medical conditions. I agree to keep the massage therapist updated as to any changes in my medical profile during the session and understand that there shall be no liability on the massage therapists part should I fail to do so. I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session. I also understand that the massage therapist reserves the right to refuse to perform massage on anyone whom he/she deems to have a condition for which massage is contraindicated.

I, hereby indemnify The Indigo Spa (Pty) Ltd, Staff and Management from any injury, disease, death, damage or loss I may experience. I declare that I will participate in all treatments at the spa facilities at my own risk and will comply with the safety protocols as detailed to me. I confirm that all the information supplied on this form is correct.

Full Name

First

Last

Layout

Date

Captcha

Quick Links

Get In Touch

Book Appointment