Name *

First Name

Last Name

Phone *

(###)

###

####

Surgery Date *

MM

DD

YYYY

Address of Stay (for Massages) *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I acknowledge and understand the policies and information provided. I am aware that the Manual Lymphatic Drainage I will receive is designed to enhance lymphatic flow, reduce swelling and bruising, promote relaxation, minimize scar tissue and fibrosis, improve range of motion, and improve posture. I understand that the pressure and techniques used during the session may cause some discomfort or pain. If this happens, I will communicate with the therapist during the session, and they will adjust accordingly based on my comfort level. *

I Understand