Intra-Oral/TMJ Consent Form
Please review the consent information below and provide your acknowledgment to proceed with intra-oral massage therapy for TMJ and related conditions.
Consent Explanation
Consent for Intra-Oral Massage Therapy
I understand that intra-oral massage therapy is a treatment for TMJ (temporomandibular joint) disorders, headaches, sinus issues, neck, shoulder, and jaw pain. This treatment may include work on the head, neck, face, and jaw musculature, including the muscles of mastication located inside the mouth.
I acknowledge that the practitioner may use a clean, gloved hand to treat the TMJ and surrounding musculature. I understand that this service may involve working on muscles that have not been treated before, and I anticipate there may be some tenderness as a result.
By signing below, I consent to receive intra-oral massage therapy as described above.
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