Functional Rating Index

With respect to other clients, we request 24 hours’ notice should you need to reschedule or cancel your appointment.We have specifically kept your appointment for you. Cancellation fees will apply should appropriate notice not be given.

Cancel or reschedule with less than 4 hours’ notice: 50% booked appointment fee if we cannot fill the appointment

Missed appointment: 100% cancellation fee.Late arrivals will result in an abbreviated appointment.

I understand that the massage I receive is for the purpose of stress reduction and relief from muscular tension, spasm or pain and to increase circulation. If I experience any pain or discomfort, I will immediately inform the massage practitioner so that the pressure or methods can be adjusted to my comfort level. I understand that massage professionals do not diagnose illness or disease or perform and spinal manipulations, nor do they prescribe any medical treatments, and nothing said or done during the session can be construed as such. I acknowledge that massage is not a substitute for medical examination or diagnosis and that I should see a health care provider for those services. Because massage should not be performed under certain circumstances, I agree to keep the massage practitioner updated as to any changes in my health profile, and I release the massage professional from any liability if I fail to do so.

By my signature I authorise Bayside Family Chiropractic to provide remedial massage to my child or dependent under 18years of age. I understand I am required to say with my child or dependant during the massage.

What is Dry Needling? Dry Needling is a form of therapy in which fine needles are inserted into myofascial trigger points (painful knots in muscles), tendons, ligaments or near nerves in order to stimulate a healing response in painful musculoskeletal conditions. Dry Needling is not acupuncture; in fact, it is modern intervention treatment of pain and dysfunction in musculoskeletal conditions: neck pain, shoulder impingement, tennis elbow, carpal tunnel syndrome, headaches, knee pain, shin splints, plantar fasciitis, or low-back pain.

What are the risks with dry needling? The possible risks and adverse reactions to Dry Needling therapy include but are not limited to temporary pain, bleeding, bruising, infection, dizziness, nerve injury, pneumothorax, pregnancy termination, changes to blood pressure, rash, fainting, muscle soreness &fatigue. Serious Adverse Events (AE’s) Pneumothorax, Cardiac Tamponade & damage to organs (0.04% Mild or moderate AEs included bruising (7.55%), bleeding (4.65%), pain during treatment (3.01%), and pain after treatment (2.19% Uncommon AEs include aggravation of symptoms (0.88%), drowsiness (0.26%), headache (0.14%), and nausea (0.13% Rare AEs fatigue (0.04%), altered emotions (0.04%), shaking, itching, claustrophobia, and numbness, all 0.01%. Brady, S et al. Journal of Manual and Manipulative Therapy 2013 VOL. 000 NO. 000 (2013)

Please tick below if you have had any of the following.

Statement of Consent – I confirm that I have read and understand the above information, and I consent to having Dry Needling treatments. I understand that I can refuse treatment at any time.

What is Pregnancy Massage?

Pregnancy or prenatal massage is used to reduce stress, reduce swelling in the arms and legs and relieve muscle and joint pain in pregnant women. Pregnancy massage can help you cope with the changes to your body that occur while you are pregnant. It can be especially useful to ease discomfort at a time when you can't use some medicines or some other medical options.

Please tick below if you have had any of the following.

STATEMENT OF CONSENT- I confirm that I have read and understand the above information, and I consent to having pregnancy massage treatments. I understand that I can refuse treatment at any time.