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Massage Therapy Informed Consent
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Techniques to be used may include Swedish, Deep Tissue, Trigger Point, Reflexology, Joint Range of Motion Techniques and stretches, Energy work, Lymphatic Drainage, Shiatsu and Cranial Sacral.
I understand that:
Massage therapy or bodywork should not be construed as a substitute for medical examination, diagnosis or treatment of an illness. I take responsibility for consulting with my physician for any ailment or condition of concern to me.
Massage therapy/bodywork practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing in said in the course of the session should be construed as such.
I understand that my feedback is an essential element in my treatment. I have the right to terminate the session at any time, regardless of the reason.
Therapeutic bodywork and massage includes treatment to face, neck, shoulders, back, arms, buttocks, hip flexors, legs (front & back), pectorals, abdominals, ribs, hands and feet. In a professional relationship, sexual intimacy between therapist and client is never appropriate and should be reported to the Texas Department of State Health Services (www.dshs.state.tx.us) and any other complaints deemed necessary.
Massage to the breasts of females will not be engaged unless a written consent is signed.
I understand that draping is to be used, preferred method is to be covered at all times, meaning only the body part being massaged will be exposed, no exceptions. In some cases, such as stretching and movement exercises, you will be asked to wear workout clothes or a swimsuit. Your modesty will be honored at all times.
I have read and understood this Client Intake and Health History Form in its entirety. if at any time there are changes in the information given, or in my condition, I will notify the therapist and update this form before receiving additional massage. I have stated all my known medical conditions and have answered all the questions honestly. I understand that any information exchanged during a massage/bodywork session is confidential and is only used to provide me with with the best health care services.
The massage/bodywork treatment I am requesting is for the purpose of relaxation, stress reduction, relief from muscle tension or spasm, to improve range of motion, circulation or energy, and to receive a positive experience of touch. If I experience any pain or discomfort during the massage session, I will immediately communicate that to the therapist so that treatment can be adjusted accordingly.
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