ASHIATSU Consent and Release form

Please fill out the following form prior to your first ASHIATSU MASSAGE with Serendipity Wellness Studio. If it is also your first massage with us, please complete the MASSAGE INTAKE FORM as well

Appointment date

First Name

Last Name

Ashiatsu Oriental Bar Therapy, the technique you will receive is a deep tissue technique. Although some clients ask for deeper compression, we prefer to keep the compression at a therapeutic level that the therapist feels comfortable with. Your comfort is our number one concern! Due to the serious nature of this technique, we would like you understand that should you experience pain, stiffness, soreness, skin irritations, marks, headaches, sinus congestion, bruises or any injury or condition, that you do not hold Serendipity Wellness Studio, Inc. liable. In addition, if you request for more compression on a higher level than that of the therapeutic range the therapist is delivering, we will not be responsible for aggravating a condition that may already be present.

By signing this release you are attesting that you have read this release in its entirety, understand nature of the technique, do not have any of the above conditions, and agree to hold harmless Serendipity Wellness Studio, Inc., Jennifer Ferdinand, any independent contractor/employee massage therapist employed by Serendipity Wellness Studio from and against any and all claims

Thanks for submitting! We are looking forward to seeing you!

Save time- complete your new client intake forms ahead of time.

ASHIATSU Consent and Release form