VERDE ORGANIC BODY Specialty Medical Release Form
By signing this form, I acknowledge that I have read, understood, and agree to the following terms and conditions required for participating in specialty wellness services—including but not limited to massage therapy, personal training, group fitness, and yoga—at VERDE Organic Body, LLC. This form applies specifically to individuals who are pregnant or undergoing/have undergone oncology-related treatment.
Disclosure and Accuracy of Health Information
I affirm that I have completed the Health History Intake Form fully and accurately to the best of my knowledge. I agree to promptly disclose any updates or changes to my medical status—including pregnancy, cancer diagnosis or treatment, surgery, or other health conditions—prior to any massage, exercise, or movement sessions. I understand that this disclosure is essential to ensure safe and appropriate care.
Scope of Services and Medical Disclaimer
I understand that the services offered at VERDE Organic Body, LLC—including massage therapy, personal training, yoga, fitness classes, and other wellness modalities—are complementary health practices. These services are not a substitute for medical diagnosis or treatment provided by a licensed physician. I acknowledge that no content, advice, or service provided by VERDE staff should be interpreted as medical advice or used as a replacement for necessary medical care.
Assumption of Risk and Liability Waiver
I voluntarily assume all risks associated with participating in massage and/or exercise services. These may include, but are not limited to, muscle soreness, fatigue, injury, aggravation of pre-existing conditions, or unforeseen physiological responses. I hereby release, indemnify, and hold harmless VERDE Organic Body, LLC, its owners, practitioners, instructors, employees, contractors, and affiliates from any and all liability, claims, demands, or causes of action arising out of or related to my participation in these services.
Prenatal Clients
If I am currently pregnant or become pregnant while receiving services at VERDE Organic Body, LLC:
I understand that Prenatal Massage and Prenatal Exercise services are provided with specialized care and consideration for my stage of pregnancy.
If I have or develop a high-risk pregnancy, I agree that this document serves as a release from my OB/GYN or licensed healthcare provider stating I am cleared to receive massage and/or engage in physical activity.
I acknowledge that even with clearance, I assume full responsibility for any outcomes associated with participating in services during pregnancy.
Oncology Clients
If I am undergoing or have undergone treatment for cancer (e.g., surgery, chemotherapy, radiation, immunotherapy):
I understand that Oncology Massage and Exercise for Cancer Recovery require tailored modifications to ensure safety, based on my diagnosis, treatment stage, and overall condition.
I agree that this document serves as a medical release and clearance from my oncologist or physician indicating that I am approved to receive massage therapy and/or engage in physical activity.
I acknowledge that services may be adjusted in duration, intensity, or technique to accommodate my medical needs, and I accept any risks involved in receiving such care.
Consent and Acknowledgment, by signing below:
I confirm that I have read and understand all of the above terms.
I acknowledge that I am voluntarily choosing to participate in massage therapy and/or exercise services at VERDE Organic Body, LLC.
I accept responsibility for notifying my practitioner of any medical changes prior to each session.
I understand and accept the potential risks involved in these services and waive any right to hold VERDE Organic Body, LLC or its team liable for any adverse outcomes related to my participation.
