Patient´s consent

This declaration must be returned before the start of the treatment.

I declare that I stall observe all the above instuctions and that I do not suffer from any of the conditions or illnesses stated below – contra-indications for Whirlpool bath, Alternating leg shower, Aromatherapy overall, Classical massage overall, Hot Stone massage, Honey massage, Reflex foot massage, Underwater massage, Cupple massage, Rolletic massage, Parafin wrap, Peat wraps small (2 places), Lymph drainage of lower limbs by appliance, Cinnamon Pack anti- cellulite.

I also declare if anz changes in mz health have occurred, I have an obligation to disclose this fact.

First name and surname ................................................................................. 

Date of birth ................................................................................................

Permanently resident at .................................................................................

Karlovy Vary, on .............................. Client´s signature ....................................

Summary: