I understand that the bodywork I receive is provided for the purpose of relaxation and relief of muscular tension. If I expe¬rience pain or discomfort during the session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that bodywork should not be construed as a substitute for medical treatment.
I understand that my bodywork practitioner is not qualified to diagnose, prescribe or treat physical or mental illness and that nothing said in the course of the session given should be construed as such. Because body work should not be performed under certain conditions, I affirm that I disclose to my practitioner all my known medical condition, and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medi¬cal profile and understand that there shall be no liability on the practitioner’s part should I forget to do so.
I also understand that any inappropriate behavior on my part will result in immediate termination of the session and I will be liable for full payment of the scheduled appointment. I understand that if I cancel an appointment within 48 hours of start time, I am responsible for full session payment.
Minor Consent: I certify that I am the legal guardian of the individual receiving bodywork today and I authorize their session.
Acupuncture: You hereby request and consent to receiving acupuncture treatments and other related procedures including but not limited to acupuncture, moxibustion, cupping, Tui-Na (Oriental massage) and Gua Sha (collectively "Acupuncture"). You are required to advise your acupuncturist of any medical conditions, including pregnancy, which may prevent you from receiving Acupuncture. You are required to inform the acupuncturist if at any time during your Acupuncture treatment you experience any pain or discomfort. You have been advised of the possible benefits of receiving Acupuncture including, but not limited, to pain management, reduced severity of certain symptoms, and treatment of certain conditions. You have also been advised of the possible risks associated with Acupuncture including, but not limited to, bruising, numbness or tingling near the needling sites which may last a few days, infection, dizziness, fainting, spontaneous miscarriage, nerve damage and organ puncture, bums, scarring, pneumothorax, and death. We reserve the right to terminate or refuse services for inappropriate behavior.
You are advised that all records pertaining to your Acupuncture will be kept confidential and will not be released by us without your written consent, unless otherwise required by law. Except for negligent or intentional acts or omissions of NAMTI Spa, you on behalf of yourself, your successors, heirs and assigns hereby release NAMTI Spa, and their related entities, and the trustees, directors, officers, employees, staff members, agents or contractors, of each, in their personal or representative capacities, of and from any and all liability for any claims or demands for harm, damages, judgments, verdicts, settlements, or otherwise, arising from any injury or damage resulting from the Acupuncture.