Massage Intake Medical History
, have informed the massage therapist of all my known physical conditions, medical conditions and medications, and I will keep the massage therapist updated on any changes. I understand that there shall be no liability on the therapist’s part should I forget to do so. I have carefully read all the above information and am fully aware of what I am signing. I understand that I may ask the massage therapist for additional information before signing this consent form. I give my permission and consent to massage therapy. If under age of 18, guardian signature is required.
I understand that massage therapy and bodywork is intended to enhance relaxation, reduce stress, increase range of motion, and offer relief from muscular tension, spasm or pain. I also understand that it may increase circulation and energy and blood flow. If I experience any pain or discomfort during this session, I will immediately inform the massage therapist so that the pressure may be adjusted to my comfort level. I have been notified that, for therapeutic benefit, discomfort may be present and will be discussed and agreed upon by, both myself, and the massage therapist. The general benefits of massage therapy, possible contraindications, and the treatment procedure have been explained to me. I understand that massage therapy is not a substitute for medical treatment or medications, and that it is recommended that I concurrently work with my Primary Caregiver for any condition that I may have. I am aware that the massage therapist does not diagnose illness or disease, does not prescribe medications, and that spinal manipulations are not part of massage therapy. Accessory Techniques:
Standard rates vary from $60-$75/hr and $90-$100/90-min session, depending on location. Cancellations within 24 hours may be subject to paying full session fee. Returned checks are subject to a $25 fee.