Lavande Difference
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Lavande Difference
Services
Therapist
Policies
Forms
Contact Us
Lava Shell Consent
Lava Shell Massage Consent Form
Name
*
First Name
Last Name
Phone
*
Email Address
*
Do you currently have any of the following medical conditions: Cardiovascular Disease; Diabetes; Neuropathy?
*
Some medical conditions require a doctor's approval before heated therapies can be used
Women are you currently pregnant
Lava Shells is contraindicated throughout pregnancy
No
Yes
Lava Shells continue to generate heat for up to an hour. Heat dissipates throughout the massage; when shells are stationary they continue to heat up. By initialling below, I acknowledge that when shells are exhanged new ones will be hotter, and it is my responbility to inform my therapists if shells are too hot.
*
By initialling below, I acknowledge that it is my responsibility to inform the therapist immediately if lava shells are ever too hot. I understand failing to inform my therapist that burns may result. By initialing I waive any liability to Lavande
*
By initialing below, I consent Lavande therapists to use heated lava shells throughout my massage. I retain the right to stop or change the service to a non-heated therapy at any time
*
Thank you!
Health History
Utah Massage Waiver
Lava Shell Consent
Soft Cupping Consent
Prenatal Massage Form
Kinesio-tape Consent
