Hot stone or hot/cold stone massage is not suitable for everyone. You must inform your massage therapist if you have any of the following conditions which may make hot stone massage contraindicated or may require the therapist to alter the treatment.

-Pregnancy
-Diabetes
-Inflammatory skin conditions
-Open wounds or sores
-Hypotension or Hypertension
-Cancer (with or without treatment)
-Varicose Veins
-Under the influence of drugs or alcohol
-Blood clot(s)
-Neuropathy
-Autoimmune Condition (MS, Lups, RA, etc)
-Peripheral vascular disease
-Heat sensitivity
-Compromised immune system
-Edema or Lymphedema
-Cardiovascular disease

Accuracy of Information:
I certify that the above medical information is correct to my knowledge and have disclosed any & all health risk factors.

Client’s Release for Hot Stone Massage:
-I have read and understand the aforementioned conditions which make hot stone massage contraindicated. I understand that I will be receiving hot stone massage as an adjunct form of healthcare only and that this therapy is not meant to replace appropriate medical care. I release the massage therapist and Urban Massage & Wellness Inc of any and all liability for any harm that may unintentionally occur during. my treatment(s).

-I understand the information contained in this form and confirm that I do not have any of the above conditions.

-My condition(s) checked off above are appropriately managed/monitored by my physician. I understand hot stone massage is considered contraindicated. Given this knowledge I hereby consent to receive hot stone massage and take full responsibility of any side effects or harm that may come from my receiving hot stone massage.