CONSENT & WAIVER 

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• I understand that bodywork and yoga are for the purposes of stress reduction; relief from muscular tension, spasm, and pain; general relaxation; and for improvement of circulation and balance of energy flow. 

• I understand that results will vary depending on the individual and the extent of his/her condition. 

• I understand it is the client’s responsibility to notify the practitioner immediately if the client should feel their well-being is being compromised in any way. 

• I understand that Thai Yoga Practitioners and Yoga Teachers do not diagnose illness nor do they prescribe medical treatment. 

• I understand that Thai Yoga Bodywork and Private Yoga are not substitutes for medical examinations or diagnosis. 

• I understand it is recommended that I see my primary health care provider for exams and diagnosis of ailments I may have. 

• I understand the practitioner does not prescribe medical treatment nor does he/she perform any spinal manipulations. 

• I understand that any information offered by the practitioner is for educational purposes only.

• I have consulted a medical doctor or licensed medical health care practitioner regarding any listed or described conditions.

• I have stated all of my known medical conditions on the form below, including any of the following:

     

      Current/Recent Illness
      Current/Recent Pregnancy
      Muscle Strain/Sprain
      Back/Neck Pain
      Low/High Blood Pressure
      Blood Clots/Heart Attack/Stroke 
      Arthritis/Osteoporosis 
      Chronic Illness
      Allergies
      Skin Infections or Diseases
 

 

I realize it is solely my responsibility to provide updates to the practitioner. BY SUBMITTING THIS FORM (BELOW) I assume full responsibility for receipt of Thai yoga bodywork and release and discharge the practitioner from any and all claims and liability.

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