Client Consent and Liability Waiver

Lymph Me Up Studio

1101 S. Winchester Blvd., Suite J-210, San Jose, CA 95128
(408) 691-7999, lymph.me.up@gmail.com

Effective Date: May 25, 2026

1. Nature of Services

I understand that Lymph Me Up Studio provides wellness and bodywork services within the practitioner’s training and professional scope. These services are intended to support relaxation, comfort, mobility, and general well-being.

Services may include Manual Lymphatic Drainage (MLD), LPG Endermologie, integrative bodywork, abdominal massage, Visceral Manipulation, Neural Manipulation, CranioSacral Therapy, SomatoEmotional Release, NeuroReceptor Therapy / P-DTR-based work, Biofield Tuning, LIMFA pulsed electromagnetic field (PEMF) sessions, and appropriate pre- and post-operative bodywork support.

These services do not replace medical care, diagnosis, physical therapy, psychotherapy, or care from a licensed healthcare provider. My practitioner does not diagnose illness, prescribe medication, perform spinal adjustments, or provide surgical or wound care.

2. Consent to Selected Services

My consent applies only to the services I select and the techniques discussed with me before they begin. Signing this form does not give blanket permission for every service offered by the studio.

Before receiving a service, I may ask about its purpose, relevant risks, alternatives, and any precautions related to my health. I may delay or decline a service until my questions and concerns have been addressed.

Additional services or material changes in techniques require discussion and my consent.

3. Health Information and Disclosure

I will complete my intake form accurately and disclose relevant health information to the best of my knowledge. Before each session, I will report changes in my health, medications, injuries, symptoms, or medical instructions.

Relevant information includes, but is not limited to:

  • Pregnancy or possible pregnancy.

  • Recent surgery, injections, injuries, or other procedures.

  • Cancer history or current cancer treatment.

  • Known or suspected blood clots, unexplained swelling, heart or kidney conditions, bleeding disorders, or use of blood thinners.

  • Fever, infection, skin irritation, open wounds, or contagious illness.

  • Fractures, osteoporosis, recent concussion, or seizure history.

  • Pacemakers, implanted electronic devices, or other medical implants.

  • Allergies or sensitivities to products, touch, pressure, sound, vibration, or positioning.

These examples are not a complete screening checklist. A disclosed condition may require further review, modifications, medical clearance, or postponement. Medical clearance does not override a service’s contraindications or the practitioner’s scope.

I will not use these services to delay necessary medical evaluation or change prescribed treatment without consulting my healthcare provider.

4. Service-Specific Considerations

Only the information relevant to my selected services applies to my session.

  • Manual Lymphatic Drainage: MLD uses light, rhythmic touch. The cause of swelling and any medical restrictions may need review before a session. New or unexplained swelling may require medical evaluation.

  • LPG Endermologie: LPG uses a motorized handpiece with suction and mechanical movement. Temporary redness, tenderness, bruising, or skin irritation may occur. Settings and treatment areas will be discussed with me.

  • Integrative, abdominal, visceral, and neural bodywork: These approaches may involve gentle pressure, movement, or work around sensitive areas. Temporary tenderness or an increase in existing discomfort may occur. Abdominal work requires my specific permission.

  • CranioSacral Therapy, SomatoEmotional Release, and P-DTR-based work: Sessions may involve light touch, movement, muscle-response testing, or sensory input. These approaches are not medical diagnostic tests or psychotherapy. I may decline any technique or discussion.

  • Biofield Tuning: Sessions use tuning forks around the body and, with my permission, on the body. I will disclose sensitivities to sound or vibration and report discomfort or emotional distress. Biofield Tuning is a wellness practice, not a medical diagnostic procedure.

  • LIMFA / PEMF: Suitability must be reviewed according to the device’s instructions and applicable precautions. I will disclose pregnancy, implanted electronic devices, and other relevant medical information before use.

  • Pre- and post-operative support: Sessions are limited to appropriate wellness and bodywork support. They do not include wound care, drain management, work on open incisions, or expressing fluid through incisions. I will follow my surgeon’s instructions and disclose complications and restrictions.

5. Comfort, Boundaries, and Ongoing Consent

All services are professional and non-sexual. Appropriate privacy and draping will be maintained.

I may decline any technique or body area, request changes in pressure or positioning, or stop a session at any time. I will promptly report pain, dizziness, nausea, distress, or another uncomfortable response. Silence does not replace consent.

This form does not authorize breast or genital work, internal vaginal or rectal techniques, photography, or recording.

The practitioner may modify, postpone, or discontinue a service if it is not appropriate for my health, comfort, or safety.

6. Risks and Individual Responses

I understand that individual responses vary and that no specific result is guaranteed. Depending on the service, temporary soreness, tenderness, redness, bruising, skin irritation, lightheadedness, emotional discomfort, or an increase in existing symptoms may occur.

I may choose a different service or no service. If symptoms are severe, persistent, or concerning, I will seek appropriate medical attention.

7. Assumption of Risk and Limited Release

I voluntarily accept the inherent risks of the selected services that are explained to me before I choose to proceed.

To the extent permitted by law, I release Lymph Me Up Studio and the practitioner providing my services only from claims arising solely from those inherent risks when services are appropriately provided.

This release does not cover negligence, gross negligence, recklessness, fraud, intentional misconduct, unlawful acts, failure to obtain informed consent, or any liability that cannot legally be waived.

Nothing in this form waives my non-waivable legal rights.

8. Privacy and Financial Policies

I understand that my intake information is used to review the suitability of services and support my care. Signing this form does not authorize the use of my health information, photographs, recordings, or testimonials for advertising or marketing.

I have the opportunity to review the service price, Financial Terms, and Cancellation Policy before booking or purchasing. Payment obligations are governed by those disclosed terms and applicable law.

Signing this form does not, by itself, authorize charges to a stored payment card.

9. Electronic Consent and Signature

I have read and understand this form. I understand that I may ask questions before receiving services and may withdraw my consent to any technique before or during a session.

I agree to complete and sign this form electronically. By checking the acknowledgment box and typing my full legal name below, I intend to provide my electronic signature.

I may request a copy of my completed form. If I prefer a paper form, I may contact the studio before submitting this form.

For clients under 18, a parent or legal guardian must complete a separate consent process before services are provided.

Questions or requests:
Lymph Me Up Studio
lymph.me.up@gmail.com