Disclaimer and Consent
To the best of my knowledge, the information I have given is true, and I have not withheld any information concerning my health. I will keep Vicky Griffiths updated on my health should there be any changes to the answers given.
I understand that the therapist does not diagnose illness, disease or any other physical condition and should not be a substitute for medical examination, diagnosis or treatment.
If I currently have, or develop, any conditions or symptoms in the two sections highlighted above (*) I will discuss the condition with Vicky Griffiths, and will have a medical consent for massage signed by GP or consultant before continuing with massage treatment.
Any information exchanged is confidential and is only used to provide a better health care service.
I am happy to be contacted with information on Massage Therapy by Vicky Griffiths and understand that I have the right to withdraw this ‘consent to be contacted’ at any time. I confirm that Vicky Griffiths may use the information provided in this form, and any other information that I later provide, for treatment purposes and that this information:
will be used in confidence and stored securely
will not, in any circumstances, be shared with a third party without my written consent
will be retained by Vicky Griffiths for a period of time such as complies with professional, legal and insurance requirements that she must fulfill.
I understand that there is a possibility I may experience some minor reactions as my body adjusts to the treatment.
If I am not able to make a scheduled appointment I agree to cancel the appointment 24 hours in advance. If I miss a scheduled appointment without giving 24 hours notice, I agree to pay any missed appointment charge.