Hot Stone Massage Consent Form
Review and confirm your consent for a hot stone massage session.
Full Name
*
First Name
Last Name
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you have any of the following conditions? (Check all that apply)
*
Circulatory problems (e.g., heart disease, blood clots)
Skin conditions (e.g., rashes, open wounds)
Recent surgery or injury
Allergies to oils or stones
Pregnancy
None of the above
Other
Are you currently experiencing fever, infection, or any contagious illness?
*
Yes
No
Please list any medications you are currently taking (if any):
Signature
*
Submit Consent
Submit Consent
Should be Empty: