Informed Consent
Please read the following information and acknowledge your acceptance and consent to treat by checking the "I Have Read and Understand" box next to each section.
Name *
Your answer
I acknowledge that it is my choice to receive massage therapy and I consent to receive treatment. I will participate fully in my treatment through communication with my therapist regarding preferences, concerns, or questions I may have. I understand there are no guaranteed results from massage therapy. *
I understand that a massage therapist does not diagnose any medical, mental or emotional illness, nor prescribe medical treatment, pharmaceuticals, or perform structural or spinal adjustments. I have stated all conditions that I am aware of to the best of my knowledge and will inform my therapist of any changes to my health as they occur. *
I understand that the massage I receive is strictly for well-being and therapeutic purposes and is not in any way sexual in nature. Any behavior that is deemed inappropriate will result in immediate termination of the session and I will be responsible for payment of the scheduled appointment. *
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