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Health Declaration

Please fill out the following form
in order to participate in our activity.

Did your Personal Doctor gave you permission for a massage therapy
Did you had a massage/cupping therapy before?

It is my choice to receive massage therapy. I am aware of the benefits and risks of massage and give my consent for massage. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status and I release the massage therapist Ioannis Odysseos and Muscle and Wellness from any liability if I fail to do so . I understand that my personal health information will be collected. I understand that all information that I provide will be kept confidential unless required by law. Also I accept to receive calls, text or emails for communication and promotion from Muscle and Wellness.

Thanks for submitting!

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