l understand that the Manual Lymphatic Drainage I receive is provided for the basic purpose of improving the flow of my lymphatic system and also for relaxation If I experience any pain ordiscomfort during this session, I will immediately inform the practitioner so that the pressure and/or strokes may be adjusted to my level of comfort
I further understand that massage or bodywork should not be construed as a substitute for medical examination diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment of which am aware.
I understand that massage/bodywork practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such
Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the proctitioner updated as to any changes in my medical profile and understand that there shall be no liability on the proctitioner's part should fail to do so.
"Please Note: Manual Lymphatic Drainage (MLD) is a very powerful modality and certain medical conditions are contraindicated and determine if and when you can receive a session After the consultation and review of the information you have provided on this form, it will be determined if MLD should be administered to you today. Some conditions will require a note from your doctor before proceeding Please understand this is for your sofety and well-being. In consideration tor treatment received I hereby grant permission to (Nome ot Facility) to use any photographic treatment records for the purposes of clinical and statistical studies, advertising or promotion without any additional compensation to me.