Prenatal Waiver

High Risk Pregnancy

Caution is advised with certain high-risk pregnancy conditions. You are responsible for communicating with your therapist about any conditions they need to be aware of and or having a doctors note if needed.

Massage therapy is safe in most high-risk cases, however, caution is advised with specific conditions that may occur during pregnancy such as, but not limited to, pre-eclampsia, being prescribed bedrest, and or being prone to miscarriage. If you currently have any of these conditions, a current doctor's note is required before receiving any massage therapy treatment.

You must inform you massage therapist if you have or have had any of the previously mentioned conditions which my be contraindications for receiving massage therapy treatment or may require your therapist to alter the massage as necessary. 

Waiver

I have read the aforementioned conditions in which we advise caution when proceeding with massage therapy during pregnancy. I have disclosed any and all high-risk factors of my pregnancy.

I understand the information contained on the form and confirm that (1) I am receiving medical care including regular check-ups with a licensed healthcare provider. (2) I am NOT currently experiencing any contraindications for massage therapy treatment and/or I have a current doctors note stating that I can receive massage therapy treatment.

I understand that I am receiving massage therapy as an adjunct form of care only and that this therapy in not meant to replace appropriate medical care. I give my consent for treatment and release the massage therapist of any and all liability for any harm that may unintentionally occur during my treatment(s).

By signing below you confirm that you have read and understood this Prenatal Release form, that the information you have entered is current and complete and that you agree to abide by the contents contained herein. By signing this release, I hereby waive and release my massage therapist from any and all liability, past, present, and future relating to prenatal massage therapy received at Evergreen Massage.