For my records, I need to confirm that you have read, understood and answered all of the previous questions. If there is anything you do not understand, or wish to ask about, please ask me now (before signing this statement).
Otherwise, please read the following statement, and sign below to show that you agree.
To the best of my knowledge, the information I have given in this form is true, and I have not withheld any information concerning my health.
I will keep Ema Melanaphy updated on my health, should there be any changes to the answers already given.
If I have, or develop any medical complications (marked with * in the list above) I will discuss the condition with my massage therapist, and will get a medical release signed by my pre-natal care provider, before continuing bodywork.
