Lockton Chair Massage Sign Up Please complete the form below. First Name(Required) Last Name(Required) Email(Required) Phone(Required)Chair Massage ConsentChair massage takes place in a portable massage chair, designed for your comfort and support. It is given by a professionally trained massage practitioner. Sessions will be in 20-minute increments which includes time to get situated and share the areas you would like addressed and any health history pertinent to receiving the service. You remain fully clothed while the therapist applies massage techniques to areas of tension such as the head, neck, shoulders, back, arm and hand muscles. By signing up for this service, you agree to the following: I give my permission to receive a chair massage from a Liam Stanbridge, a licensed massage therapist through Small Changes Big Shifts Co. (SCBS). I do not have any injuries or conditions that would prevent me from receiving a chair massage, nor have I been told by a health provider that I should not receive massage therapy.I understand that massage therapy and bodywork are for the purposes of stress reduction, relief from muscular tension or spasm, general relaxation and improvement of circulation and energy flow. It is not a substitute for medical care and qualified medical diagnosis nor treatment. I understand that the therapist may ask me questions about my general health and physical condition and that I am obligated to be truthful about my health history. I will notify my therapist of any discomfort and if I need more or less pressure. I understand the risks of massage therapy - including but not limited to superficial bruising, short-term muscle soreness, and exacerbation of an undiscovered injury – and release massage therapist and SCBS from any liability concerning that may occur during the service. I understand that it is my responsibility to arrive on time to my schedule appointment. If I arrive more than 5 minutes late, I may need to reschedule or forfeit my appointment, depending on availability.Chair Massage Consent(Required) I agree.Chair Massage FeePlease pick a Chair Massage time:(Required)Wednesday, January 22ndSelect a time...9:00 AM - (1 spot left)9:20 AM (1 spot left)9:40 AM (1 spot left)10:00 AM (1 spot left)10:20 AM (1 spot left)10:40 AM (1 spot left)11:00 AM (1 spot left)11:20 AM (1 spot left)11:40 AM (1 spot left)12:00 PM (1 spot left)Credit Card Total Payment Consent(Required) I agree. I agree to "Small Changes Big Shifts (SCBS)" collecting my contact and billing information listed above. I authorize “Small Changes Big Shifts (SCBS)” to charge my credit card for the for the one-time amount shown above. Per the terms of service under which my credit/debit card was issued, I agree to pay the amount shown here and confirm that I am an authorized user of this credit card. Δ