Please take a moment to complete and submit the form below.  Please be assured that your information is secure. I will contact you as soon as possible after receiving it.
 
  

Privacy of personal information collected on this form is an important principle of ‘Kimberly McMahon Massage Therapy’. It is collected to better administer the personal care you require. Information is never shared and is safeguarded against loss, or theft from unauthorized access.

CONSENT FOR PERSONAL INFORMATION

By completing and submitting this form I consent to the collection and utilization of personal information, to better provide me with the Registered Massage Therapy I need.

I understand that by submitting this form I will receive email messages about upcoming appointments and a (COVID-19) screening questionnaire before each appointment.

LIABILITY RELEASE

By completing and submitting this form, I understand that I am voluntarily participating in this therapy with full knowledge, understanding, and appreciation of any potential risks involved. I hereby agree to assume and accept any and all risks that I may suffer, and hereby irrevocably release ‘Kimberly McMahon Massage Therapy’ from any liability with respect to these risks while participating in a massage therapy activity.