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Informed Consent

The document is an informed consent form for massage therapy. It summarizes that massage is intended to enhance relaxation, reduce pain, improve range of motion and circulation. It states that massage therapy is not a medical treatment and does not diagnose or prescribe medications. It requires clients to inform the massage therapist of any medical conditions, pain experienced during sessions, and acknowledges policies regarding inappropriate conduct. For minors, it requires parental consent for massage therapy techniques.

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165 views1 page

Informed Consent

The document is an informed consent form for massage therapy. It summarizes that massage is intended to enhance relaxation, reduce pain, improve range of motion and circulation. It states that massage therapy is not a medical treatment and does not diagnose or prescribe medications. It requires clients to inform the massage therapist of any medical conditions, pain experienced during sessions, and acknowledges policies regarding inappropriate conduct. For minors, it requires parental consent for massage therapy techniques.

Uploaded by

api-358259684
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as ODT, PDF, TXT or read online on Scribd
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INFORMED CONSENT

I, _________________, (Client) understand that massage provided by Massage Haven is


intended to enhance relaxation, reduce pain caused by muscle tension, increase range of motion,
improve circulation and offer a positive experience of touch. The general benefits of massage, possible
massage contraindications and the treatment procedure have been explained to me. I understand that
massage therapy is not a substitute for medical treatment or medications, and that it is recommended
that I concurrently work with my Primary Care Physician for any condition I may have. I understand
that the massage therapist does not diagnose illness or disease and does not prescribe medical treatment
or pharmaceuticals, nor are spinal manipulations part of massage therapy.. I have informed Massage
Haven of all my known physical conditions, medical conditions and medications, and I will keep
Massage Haven updated on any changes. I will inform the massage therapist of any experience of pain
during the session. I understand that no inappropriate comments or conduct will be tolerated and that
any indication of such will automatically end the session. I further understand that massage will be
administered at the discretion of the massage therapist and any medical condition contraindicated to
massage will disqualify me from participating in the massage practice. I understand that the massage
will begin and end at the time agreed and I will be charged for any delay caused by me. I understand
and agree to all Massage Haven policies.
Client Signature: ___________________________________________Date:___________________

CONSENT TO TREATMENT OF MINORS


(Please use this portion for consent to provide massage therapy to those less than 18 years old)
I, __________________________ (Parent/Guardian) hereby consent Massage Haven to administer
massage therapy techniques to _______________________. (massage recipient) my child of dependent
as deemed necessary. Parent/guardian understands that there can be a remote risk associated with this
work.

Parent/ Guardian Signature:_____________________________________Date:___________________

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