Pregnancy massage consent form
  • Pregnancy massage consent form

    Please complete in addition to The Barn’s standard consultation form.
  • I am currently experiencing a low/high risk pregnancy as stated by my midwife/Dr please tick appropriate box.
  • Please carefully check and tick the list below if you have had or currently have any of the issues listed.
  • Please carefully check a tick the list below if you have had or currently have any of the issues listed.
  • If I am experiencing any of the above conditions or develop complications during my pregnancy, I will fully discuss this with my massage therapist and will agree to have a medical release form signed by my midwife/Dr before commencing with any further treatment. 
    This form has been completed to the best of my knowledge. I fully understand that massage is a complementary treatment and does not take the place of any medical care.

    All information exchanged with the therapist  is strictly private and confidential and used for the sole purpose of providing the best care possible.

     

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