Inland Mobile Massage

Relaxing, Therapeutic Massage at your Residence, or Business. (909) 803-4018

Intake Form
When you have booked a massage with us, your massage therapist will bring an Intake Form for you to read over and sign. You will need to sign your Intake Form, and consent to the following release before your massage therapist can perform your massage. 

Consent
I understand that the massage I will receive is for the purpose of relaxation, stress relief and the relief of my muscular tension. If during my massasge, I experience any pain or discomfort, I will immediately inform the massage therapist, so that the pressure and-or touch may be adjusted to my level of comfort.

Also, I understand that massage should not be construed as a substitute for a medical examination, a diagnosis, or a treatment. I should see a physician, chiropractor or other qualified medical specialist for any mental or physical ailment I am aware of. I understand that massage therapists are not to perform any spinal or skeletal adjustments, diagnose, prescribe, and or treat any physical or mental illnesses. I understand that nothing discussed in the course of the massage given should be construed as such.

I affirm that I have stated all my known medical conditions, as well as answered all questions honestly, and to the best of my knowledge. I agree to keep the massage therapist informed to any changes in my medical profile, and understand that there shall be no liability on the massage therapist's part should I forget, or neglect to do so.

I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session.

I understand that a 60 minute massage includes dressing and undressing. The actual massage time may be anywhere from 50 to 55 minutes. Additionally, I understand that no contact information between myself and the massage therapist shall be exchanged at any point before, during or after the massage.