INFORMED CONSENT OF CARE - Massage Therapy
Please read the following information carefully.
Massage therapy involves the manipulation of soft tissues of the body to enhance health and well-being. While massage therapy is generally safe, there are potential risks, including but not limited to temporary soreness, bruising, or allergic reactions to oils/lotions. If you have any health conditions or concerns, please inform your therapist.
By proceeding, you acknowledge that you:
1. understand that massage therapy is not a substitute for medical care, medical examination, or diagnosis.
2. have been given the opportunity to discuss with the practitioner the nature of the massage treatment and other procedures which will be incorporated in today's session and you have disclosed any relevant health information, understand the nature and purpose of massage therapy.
3. understand the results may not be guaranteed.
4. understand that the practitioner is not a physician and does not diagnose illness nor disease nor any other physical or mental disorder.
5. understand, as in all health care, in the practice of massage therapy, there can be risks to treatment, including but not limited to, tenderness, bruising, light headedness, or dizziness. You do not expect the practitioner to be able to anticipate and explain all risks and complications and you wish to rely on the practitioner to exercise clinical judgment during the course of today's treatment which they feel is most appropriate at the time, based upon the facts then known, and is in my best interest.
6. acknowledge and understand that it is your responsibility to make the practitioner fully aware of your existing medical conditions. You have completed a medical history form and/or session intake form as provided by the practitioner. It is your responsibility to keep the practitioner updated on your medical history at subsequent office visits. The practitioner may request of you an updated medical history form to be completed at least every 12 months or if there is a significant event which affects your overall health. The information you have provided is true and complete to the best of your knowledge.
7. understand that, unless the treatment requires you to remain clothed, you will be draped at all times and the areas undraped will be secured to insure there is no indecent exposure. If there is undraping of sensitive areas in this session, you understand that it is appropriately warranted to address areas of concern as you have discussed during the entrance interview with the practitioner. If this is the case, you will have provided additional written informed consent for assessment and treatment of sensitive areas on a separate form.
8. will have the privacy to undress/dress and the practitioner will door knock and wait for your reply to enter the treatment room.
9. understand that if you have or in the future develop any sensitivities to lotions, oils, creams, etc., which may be used during the session, you will notify the practitioner immediately.
10. are aware there are further alternatives offered by other practitioners in the form of Chiropractic, Acupuncture, Reflexology, Physical Therapy, etc.
11. understand that the client-therapist relationship will be held in strict confidence.
12. understand the different pricing for the differing levels of care provided by this practice.
13 understand that you, the client, and this massage therapy practice, retain the right to refuse treatment for any reason at any time. Any inappropriate behavior WILL NOT be tolerated and may be subject to legal action.
In compliance with the Commonwealth of Massachusetts Massage Therapy Regulation 269 CMR 5.02 (1) & (2), a written and verbal intake interview with the practitioner was performed and documentation of informed consent is being given immediately prior to today's scheduled session.