Policies & Documents

All forms are to be downloaded, printed , and signed before treatment can begin. In order to save time please do so at your earliest convenience prior to visit.

Please view our policy statement below:

https://www.privacypolicytemplate.net/live.php?token=qzl2oRgexEntXFrxxpo80qIu9CWUiTe3

Liability Waiver

First name

Last name

Phone

Date

Are you on Medicaid or Medicare?

Yes

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

I, the undersigned, being aware of my own health and physical condition, and having knowledge of my participation in lymphatic therapy services, am voluntarily participating in the lymphatic massage treatment at Lymphatic Express LLC. Having such knowledge, I hereby acknowledge this release, any company representatives, therapists, agents, and employees from liability for accidental injury or illness which I may incur as a result of participating in the lymphatic modalities and massage treatment. I hereby assume all risks connected therewith and consent to receive the said treatment. I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in the manual lymphatic drainage treatment.

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Policies & Documents

Liability Waiver

HealthDeclaration