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Myofascial Release in Cottonwood
Massage Therapy Cottonwood
Lymphatic Drainage Massage
Accelerated Treatment Program
Cottonwood Myofascial Release Therapists
Self Care Tips
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Sitting Hamstring Stretch
SI Joint Stretch
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Myofascial Release Consent Form
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Date of Birth
MM slash DD slash YYYY
Emergency Contact Details
In case of emergency, we will contact the person below.
Emergency Contact Name
Emergency Contact Phone
Do you have any current injuries?
Location of Painful Areas
Current Medical Conditions
Pregnant or Nursing? (Female only)
Consent and Waiver
I have read and understand the Consent agreement
1. I authorize this massage spa clinic/center to perform the treatment or necessary procedure for myself or my child.
2. I understand that this is an alternative treatment and if there are any medical concerns, I need to talk to my physician.
3. I acknowledge that this massage therapy has no sexual intent and touching the therapist is strictly prohibited.
4. I release this massage spa clinic/center for any responsibility in case of an accident, illness, or injury.
5. I acknowledge that all information I provided in this form is true and accurate.
I agree to the Cancellation policy.
I agree to a 50% fee for missed appointments not cancelled or rescheduled by 9am the day before my appointment.
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