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Please read fully and complete this page prior to your appointment at the Sugar Hut Express Spa

Full Legal Name*

Appointment Day*

Any changes in contact information; medical conditions your therapist should know about? If so, please explain*

Appointment Type (check all that apply)

DISCLAIMER & WAIVER. Because a Massage Therapist must be aware of any existing physical conditions that i may have, I have listed all my known medical conditions and physical limitations and I will inform my therapist of any changes in my physical health. I understand and agree that: (1) the massage therapy that I am given is for the purpose of stress reduction, relief for muscular tension or spasm and/or for improving blood circulation; (2) that a massage therapist neither diagnoses illness, disease or any other medical, physical or mental disease/condition, nor performs any spinal manipulations; (3) I am responsible for consulting a qualified physician for any physical ailments that I may have and prior determination of whether I am physically fit and in good medical condition to receive a massage. I AM FULLY AWARE OF THE RISKS INVOLVED AND HAZARDS CONNECTED WITH SKIN CARE TREATMENTS AND/OR MASSAGE THERAPY, AND I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY THAT MAY BE SUSTAINED BY ME AS A RESULT OF THE ABOVE TREATMENT(S), OR ANY LOSS OR DAMAGE TO PROPERTY OWNED BY ME AS A RESULT OF BEING ENGAGED IN SUCH AN ACTIVITY AS THE ABOVE TREATMENT(S), WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE. I HOLD THE SUGAR HUT EXPRESS SPA, ITS OFFICERS, STAFF, AND AGENTS HARMLESS AGAINST LIABILITY. Further, I have expressly represented that I am a return client who has previously provided information as requested in the initial intake sheet and incorporate all waivers of liability herein.*

We support reduction of paper! Please fill out this page within 24 hours of your next appointment.

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