IN-HOME WRAP & RECOVERY EXPERIENCE FOR THE NEW MOTHER

Bellibind Contact & BodyWork Waiver Form

By signing below, you agree to the following:

1. I give my permission to receive gentle womb rub and body therapy.

2. I understand that therapeutic bodywork is not a substitute for traditional medical treatment or medications.

3. I understand that the BETM Specialists are not massage therapist and do not diagnose illnesses or injuries, or prescribe medications.

4. I have clearance from my physician to receive massage therapy & bodywork.

5. I understand the risks associated with bodywork include, but are not

limited to:

• Superficial bruising

• Short-term muscle soreness

• Exacerbation of undiscovered injury

I therefore release the company BelliBind and the individual specialist from all liability concerning these injuries that may occur during the bodywork session.

6) I understand the importance of informing my BETM Specialist of all medical conditions and medications I am taking, and to let the specialist know about any changes to these. I

understand that there may be additional risks based on my physical condition.

7) I understand that it is my responsibility to inform my BETM Specialist of any discomfort I may feel during the session so he/she may adjust accordingly.

8) I understand that I or the BETM Specialist may terminate the session at any time.

9) I have been given a chance to ask questions about the BelliBind session and my questions have been answered.

I certify that all details are correct as I know them for the previous following forms: