Consent Form | Alpha Omega Massage

Please complete and submit the details below prior to treatment.
This form will then be stored in accordance with GDPR Regulations.

Name

Date of Birth required

Address

Please indicate your preference for gluteal (buttock) treatment during your session:

Yes (Direct contact)

Yes (Indirect contact - pressure applied through towel)

No - I do not consent to gluteal treatment

Please briefly describe your reason for seeking treatment and list any relevant medical history.

Client Consent & Liability Waiver By submitting this form, I confirm and agree that: • I am not pregnant. • I consent to treatment including sports and remedial massage, cupping, dry needling, IASTM, LVLA mobilisations, compression boots, and percussion/massage gun therapy. • These services are not a substitute for medical care and no diagnosis or prescription is provided. • I have disclosed all medical conditions, injuries, medications, allergies, and sensitivities, have medical clearance where required, and accept responsibility for changes to my health status. • I understand risks may include temporary pain, bruising, soreness, skin irritation, nerve sensitivity, allergic reaction, or aggravation of an undiscovered condition, and I voluntarily accept these risks. • I release Grant Lindsay / Alpha & Omega Massage from all liability for injury, adverse reaction, or outcome arising from treatment. • I agree to communicate discomfort immediately and understand either party may modify or terminate treatment at any time. • I acknowledge essential oil risks and release liability for loss or damage to personal property. • Gluteal treatment consent (direct, indirect, or excluded) is selected in the booking and consent form and is my responsibility.

Please complete and submit the details below prior to treatment. This form will then be stored in accordance with GDPR Regulations.

Please complete and submit the details below prior to treatment.
This form will then be stored in accordance with GDPR Regulations.