By SUBMITTING THIS FORM, you agree to the following:

1) I give my permission to receive massage, facials or waxing services.

2) I understand that therapeutic massage is not a substitute for traditional medical

treatment or medications.

3) I understand that the therapist or aesthetician does not diagnose illnesses or injuries,

or prescribe medications.

4) I have clearance from my physician to receive facials and massage therapy.

5) I understand the risks associated with massage therapy, facials, and waxing include, but are not limited to:

•Superficial bruising or redness

•Short-term muscle soreness

• Exacerbation of undiscovered injury

I, therefore, release Marion Jenkins Therapies and the individual therapist or aesthetician from all liability concerning these injuries that may

occur during the massage session.

6) I understand the importance of informing the therapist of all medical

conditions and medications I am taking, and the massage therapist knows

about any changes to these. I understand that there may be additional risks

based on my physical condition.

7) I understand that it is my responsibility to inform the therapist or aesthetician of any

discomfort I may feel during the session so he/she may adjust accordingly.

8) I understand that the therapist may terminate the session at any time.

9) I have been given a chance to ask questions about the session

and my questions have been answered.