Watsu Intake FormSee you in the water! Name * First Name Last Name Email * Phone (###) ### #### Emergency contact: relationship, email, phone number How did you hear about me? Have you had any surgeries or broken bones in the past 2 years? Any parts of your body with limited range of motion or sensitivity to stretching? Are you comfortable in water? Are you prone to motion sickness? Watsu is an intimate form of bodywork. Are you comfortable with being held in the water? What are your intentions/expectations for this Watsu? Anything else I need to know about your body or you? Contraindications - Watsu may not be appropriate for individuals with certain medical conditions, including but not limited to: Open wounds, skin infections, or contagious skin conditions; Acute fever or infectious illness; Severe cardiovascular conditions or uncontrolled high blood pressure; Recent surgery (within the past 6 weeks); Epilepsy or seizure disorders; Pregnancy complications or high-risk pregnancy; Bowel incontinence; Severe urinary tract infection; Respiratory disease with vital capacity less than 1500cm3; Tracheotomy; Sensitivity to pool chemicals; Acute inflammation or injury; Uncontrolled diabetes; Recent fractures or dislocations. Do you have any of the above conditions or any other medical conditions that might contraindicate Watsu? If yes, please explain: I understand that Watsu makes no claim to treat medically diagnosed conditions, for which I should see a physician. I assume full responsibility for my health and will in no way hold the Watsu provider accountable for any outcome of the session. If I experience any pain or discomfort during a session, I will immediately inform the provider. I agree to keep the Watsu provider updated as to any changes in my medical profile and understand there is no liability on the provider's part should I fail to do so. I also understand that any illicit remarks or sexual advances will result in immediate termination of the session, and I will be liable for full payment. Finally, I understand that all sessions are non-refundable. If I need to reschedule my session, I will give at least 48 hours notice. I understand that if I arrive late, my session must end at the scheduled time. * By typing my name above and checking this box, I agree to the terms * Thank you!