Massage Therapy Consent and Release Form

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By checking the box, I agree to the following

 

 

I voluntarily request and consent to receiving massage therapy.

 

I understand that the massage service offered is for the purpose of general wellness, stress reduction, and

relief of muscular tension only.

 

I do not have any injuries or conditions that prevent me from receiving massage therapy.

 

I understand the importance of informing my massage therapist of all medical conditions and medications that I am taking,

and that there may be additional risks based on my physical condition.

 

If I experience any pain or discomfort, I will immediately inform my therapist so that the pressure or

techniques used can be adjusted to my comfort level. I will not hold my massage therapist responsible for

any pain or discomfort I experience during or after the session.

 

I understand the risks associated with massage therapy include, but are not limited to:

Superficial bruising
Short-term muscle soreness

Exacerbation of undiscovered injury

 

I do not have any contagious conditions that may put my massage therapist or other clients at risk.

 

I understand that I or the massage therapist may terminate the session at any time.

 

I have been given the opportunity to ask questions about massage therapy and my questions have been answered.

 

I have been advised of the policies and procedures pertaining to massage and I understand these policies. Information regarding massage in general, benefits, contraindications of massage, and possible alternative therapies have been explained to me.

 

I further understand that massage therapy is not a substitute for a medical examination or treatment, and that I should see a physician or other qualified health specialist for any mental or physical ailment of which I am aware. I understand that massage therapists do not diagnose illness or disease, and nothing said during the massage should be construed as such.

 

My consent is informed and voluntary and I understand that I may withdraw my consent at any time except for actions already taken.

By signing this form I give my consent to proceed with the massage service as outlined above.