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Self Assessment
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Informed Consent for Massage Therapists

Failure to fill out the following consent, authorizes the masseuses to reject the scheduled appointment.
The consent must be sent 24 hours before the scheduled appointment.

Note: if you have received the reservation confirmation email, please check the SPAM tray

Informed Consent Template for Massage Therapists
Name
Name
Have you had a professional massage before?
Have you ever had surgery?
Do you have any spinal problems?
Do you wear contact lenses?
Are you pregnant or do you have an IUD?
Do you wear contact lenses?
Do you have high blood pressure?
Do you suffer from chronic low back pain?
Do you have varicose veins?
Do you have frequent headaches?
He's always tired?
Do you have heart problems?
Do you take any prescription medication?
Do you have blood clotting problems?
Do you have any pain radiating down your legs or arms?
Arthritis?
Do you have diarrhea or chronic constipation?
I understand that the massages given here are intended to reduce stress, relieve tension, muscle spasms, and improve circulation.

I understand that it is not the massage therapist's job to diagnose medical conditions, illnesses, or other physical or mental disorders. As such, this masseur does not prescribe any medical treatment or medication, nor does he perform any type of spinal manipulation. It has been made very clear to me that massage is not a substitute for medical examination or diagnosis, and I have been advised to see a doctor if I am suffering from any ailment.

As this massage therapist must be aware of any medical conditions I have, I have disclosed all known medical conditions, and it is my responsibility to keep you informed of the status of my physical health.

Our time together is precious, so I agree to pay the fees 24 hours in advance. Unless it is an EMERGENCY, if I do not attend an appointment, I agree to pay the full amount of the agreed massage.

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3860 Sheridan St C, Hollywood, FL 33021

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+1 (954) 261 3366

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@equilibrium.hands

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[email protected]

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