INFORMED CONSENT
I have chosen to consult with and hereby give consent for massage therapy treatment to be provided by Tamika Ross, an independent massage therapist operating out of Bribie Acupuncture / Element Fertility & Pregnancy. I have provided a detailed medical history. I do not expect the therapist to have foreseen any previous or pre-existing condition that I have not mentioned. I understand that massage may provide benefits for certain conditions but results are not guaranteed. These benefits may include relaxation, reduction in the symptoms of stress-related conditions and provision of general wellbeing. I also understand that massage therapy may produce side effects such as muscle soreness, mild bruising, increased awareness of areas of pain and light-headedness amongst other possible temporary outcomes. I am aware that the therapist does not diagnose illnesses, prescribe medications nor physically manipulate the spine or its immediate articulations. The therapist understands that I have the right to question procedures used and to receive an explanation of any procedures that the therapist performs.
I will tell the therapist about any discomfort I may experience during the therapy session and understand that the therapy will be adjusted accordingly.
Confidentiality
Bribie Acupuncture / Element Fertility & Pregnancy adheres to all relevant State and Commonwealth privacy law requirements. All of the personal and health information we gather from you will be securely stored and will only be disclosed in circumstances where we are required by law to make such disclosures.
I will notify the massage therapist who is caring for me if I am pregnant. I do not expect the massage therapist to be able to anticipate and explain all possible risks and complications of treatment, and I wish to rely on the massage therapist to exercise judgment during the course of treatment, which the massage therapist thinks at the time, based upon the facts then known, is in my best interest.
I understand the clinical and administrative staff may review my patient records, but all my records will be kept confidential and will not be released without my written consent. By voluntarily signing below, I show that I have read, or have had read to me, the above consent to treatment, have been told about the risks and benefits of massage therapy, and have had an opportunity to ask questions. I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment.