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Massage & Acupuncture Event Consent

  • I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of circulation and energy flow. I also understand that acupuncture services provided may include needle insertions, cupping, gua sha, and/or vitamin or lipotropic injections, which are intended to support overall wellness, pain relief, energy levels, and other therapeutic benefits.

  • If I experience pain or discomfort during any service, I will immediately inform my therapist or acupuncturist so that pressure, technique, or modality can be adjusted to my level of comfort. I will not hold my therapist or acupuncturist responsible for any pain or discomfort I experience during or after the session.

  • I understand that the services offered today are not a substitute for medical care. I understand that my massage therapist and acupuncturist are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness.

  • I understand that acupuncture may involve minor discomfort, bruising, bleeding, or other skin reactions at the needle or injection sites, and that these are common and generally minor side effects. I also understand that injections provided (such as B12 or Lipo-Mino) may carry rare risks such as infection, allergic reaction, or localized irritation.

  • I understand that it is my responsibility to inform my practitioner of all known medical conditions, allergies, medications, and injuries prior to receiving any massage or acupuncture treatment, including injections. I agree to inform the therapist or acupuncturist of any changes in my health and medical condition. I understand that there shall be no liability on the practitioner’s part should I forget to do so.

  • I understand that massage and acupuncture services provided are entirely therapeutic and non-sexual in nature.

  • I understand that, because both massage therapy and acupuncture involve maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19 and other communicable illnesses.

  • By signing this release, I hereby waive and release my therapist, acupuncturist, and A Hand In Health Massage LLC from any and all liability, past, present, and future, relating to massage therapy, acupuncture, injections, and bodywork services.

  • By entering my name below, I am agreeing to all the above policies and conditions.

Thanks for submitting!

​OPENING HOURS

(Subject to change w/out notice)

Mon: 9:30am - 2:30pm

Tue: 9:30am - 2:30pm

Wed: 9:30am - 4:30pm

Thurs: 9:30am - 2:30pm

Fri: 9:30am - 2:30pm

Sat: Select Days & Times

Sun: Closed

A Hand In Health Massage LLC

418 Canal Street

New Smyrna Beach, FL 32168

TEXT Only 386-777-1652

MM40210

MA88896

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