• 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 
      Chronic Illness
      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.

Thank you for kindly agreeing to and following the studio COVID protocol as well as practicing social distancing.


Parking Lot & Entrance at back porch. Look for the orange chairs!