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Medical Waiver Form

Please fill out the following form to ensure a comprehensive, thorough and benefitial treatment at our spa, it is essential that our staff is aware of your current medical condition. This information is required to avoid contra-dictions, and will be kept on your personal file for future use.

Solterra Desert Spa

Any information provided will be held in strict confidence within the Solterra Desert Spa in adhering to the B.C. Privacy Act (2004). I certify that the information below is correct to the best of my knowledge. I will not hold Solterra Desert Spa or any of it's employees responsible for any errors or omissions that I may have made in the completion of this form. I agree to participate in the therapy(s) that I have requested, with the understanding that the treatment and care provided is for my own lifestyle guidance, personal health and relaxation. I understand that the masseuse is not a medical practioner, and I fully accept responsibility for insurance claims pertaining to massage treartments on extended health benefits.

Recent/Past Sugeries
Recent/Past Injuries
High Blood Pressure
Low Blood Pressure
Thyroid (Hyper or Hypo)
Metal Implants/Pacemaker
Heart Disease
Skin Disease/Disorder
Recent Cosmetic Surgery/Laser
Pregnant/Breast Feeding
Neck/Back Problems

Thanks for submitting!

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