Letter of consent

Client Consent & Waiver Form

Firstname *

Lastname *

Phone Number *

Email *

Please select the service you are receiving today *

Do you have any allergies? State your allergies (write “None” if none) *

Do you exercise on regularly? *

YES

Are you currently pregnant? *

YES

Please specify your request (e.g., focus on neck, shoulders, back)

Letter of Consent & Acknowledgement of Risk

I hereby confirm that, to the best of my knowledge, the information I have provided to RAKU Thai Massage & Wellnessis accurate and complete. I have not withheld any details that may be relevant to my treatment.

I understand and acknowledge that:

The massage therapist is not a medical doctor, and the services provided are not a substitute for medical diagnosis, treatment, or advice.
Massage therapy and related body treatments carry inherent risks, which may include but are not limited to allergic reactions, skin irritation, redness, muscle soreness, bruising, or other unforeseen effects.
I have disclosed any relevant health conditions, allergies, injuries, or other medical concerns prior to receiving treatment.

By signing this consent form, I voluntarily assume all associated risks and agree that:

I will not hold RAKU Thai Massage & Wellness, its owners, staff, or therapists liable for any adverse reactions, injuries, or complications that may occur as a result of the treatment, except where prohibited by law.
I release and discharge RAKU Thai Massage & Wellness from any claims, demands, or legal actions arising out of or connected to the services provided.

I confirm that I have read, understood, and agreed to the above terms before proceeding with any treatment.

Select Date-Time *

Signature *