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Client In-Take Form

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I have read and understand this waiver and have been fully informed of all Aligned Uphoria Massage (collectively referred to as “the company”) terms and conditions as well as benefits and limitations. I certify that I have disclosed all medical conditions that might affect my treatments as well as previous products and services used and their side effects, if any. The authorized staff of the company disclaims liability for any loss, injury, claim, or damage related to your use of its products and services, including without limitation, those resulting from errors or omissions, a site or application being down, data loss, and unsatisfactory aesthetic outcomes. The company will not be liable to you for any indirect, incidental, consequential, reliance, or special damages, including without limitation damages arising from any court action or legal dispute. In no event shall the aggregate liability of the company, whether in contract, warranty, tort (including negligence, whether active, passive or imputed), product liability, strict liability, or other theory, arising out of or relating to the use of the company products or services, exceed any compensation paid by you for treatment by the company during the three months prior to the date of any claim. I release my providers from any injury or complication resulting from undiagnosed medical conditions present during my treatment. I assume all responsibility for updating changes in physical and mental condition.

You are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

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