Lava Shell Consent — Lavande

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

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

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Lava Shell Consent

Lava Shell Massage Consent Form

— Lavande —