Barefoot Massage Release Form

• I understand what is involved with Barefoot Massage.

• I understand that if the pressure is too much, I will speak up to my therapist immediately as they may be using up to 100% of their body weight.

• I have disclosed any injuries, diseases, illnesses, conditions, or medications that would prevent me from receiving a Barefoot Massage, such as:

o Breast implants within 9 months

o Varicose veins, skin lesions, and boils

o Recent eye procedures

o Any acute inflammatory conditions

o Uncontrolled HIGH blood pressure or a heart condition, pacemaker, stent, or shunt

o Within 6 weeks of surgical procedure

o Persons on Coumadin, Lovenox, Heparin, or a heavy dosage of aspirin

o Any rib fracture or osteoporosis in the advanced stage

o Any recent (acute) injuries or surgeries

o Tuberculosis, thrombosis, aneurysm, kidney disorders, recent bowel or hernia surgery

o Pregnancy

I understand that the above-listed conditions are contraindicated for Barefoot Massages, and I have informed my therapist of any and all medical conditions, even those not listed as contraindications.