Form Massages & Cold Plunge | IVY Wellness Center & Spa

Massage & Cold Plunge Form

Full name

Appointment Date

Age

Type of work you do?

WhatsApp number

1. Are you pregnant or do you have an IUD? *Massages not recommended during first 3 months of pregnancy.

*Cold plunge not recommended during pregnancy, people overweight, over 60 years old or with medical conditions. We recommend our Warm Epson or Turco Soaks as an alternative.

2. Please list any skin or medical conditions (cardiovascular, diabetes, cancer, tumors, low blood pressure, etc.)

3. Please list any muscle or bone injuries you have had in the last 3 months.

PATIENT INDEMNITY

The service to be provided in IVY Wellness & Chiropractic Center are done by independent certified therapists who are responsible for their therapies performed at IVY Wellness & Chiropractic Center. The therapist will do their best to help the patient with whatever pain they have by using their experience to do the therapy.

By signing this form, the patient declares all medical info on previous page is true & complete. if any important medical info is excluded, it may affect the outcome of the service / therapy.

The patient agrees to hold harmless IVY Wellness & Chiropractic Center, its owners, employees & therapists from any liability, claims or demands resulting from their service or therapy. This includes costs arising from actions, omissions or loss to the patient or third parties.

The patient agrees to prevent any third party from filing claims (judicial or extrajudicial) against IVY Wellness & Chiropractic Center, its owners, employees & therapists by actions or omissions.

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