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Have you ever had a massage before?
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I have provided all of my known physical and medical conditions. I understand that the massage I will receive is provided for the basic purpose of relief of muscular tension and overall relaxation. I further understand that this massage is not a substitute for medical examination, diagnosis or treatment. I give my consent to receive therapy. If I experience any discomfort or pain during the session, I will immediately inform the therapist.

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The submit button will not be clickable unless all required fields are filled in. If you cannot click the submit button, please review the form and fill in any missing details. Be sure to select "I Agree" at the end as well. If all fields are filled in and something still isn't working, please email tsblmt@gmail.com or call (310) 741-8569