All new clients will be requested to read and sign the consent form below, which will be provided in paper format when you come to our treatment rooms.
Client Consent and Signature
This record of consent is required before the first assessment or treatment and will be maintained confidentially in the client file. It may only be released to a third party with prior written consent of the client.
Massage Therapy includes the assessment and treatment of the soft tissues and joints of the body, using soft tissue manipulation, joint mobilization, hydrotherapy, remedial exercises and self-care programs as determined by the therapist. Treatment plans will be discussed in advanced with the client and must be agreed upon prior to start.
By signing below, the client agrees to the following;
-
All massage treatments, information and records will be kept confidential and securely stored for use only by my massage therapist.
-
Written consent must be given by me prior to any disclosure or sharing of my personal and clinical information with any third party.
-
Privacy will be assured as I have the right to undress only to my comfort level and according to the requirements of the treatment.
-
Draping will be used by the therapist as required to expose only those parts of my body that require treatment and/or as I choose to ensure my comfort during treatment.
-
During treatment, the therapist will endeavour to work such that a pain level of 6 - 7 is not exceeded, based on a pain scale of 1 - 10.
-
If at any time during the treatment, I feel uncomfortable with the treatment for any reason, I have the right to request an immediate stop to the session or request modifications to the treatment, regardless of prior consent given.
-
Promptness is expected for all appointments. In the event of lateness, the massage may be cut short due to other commitments of the therapist. Fees will be maintained per the schedule.
-
Cancellation of any appointment must be received at least 24 hours in advance;otherwise 50% of the appointment fee is due.
-
Fees for treatment are due prior to departure on the day of the treatment. Cash or personal cheques are accepted.
-
The therapist may refuse to treat any client or part of their body with just and reasonable cause.
The information I have provided is accurate and complete to the best of my knowledge. I understand that massage therapists do not diagnose or treat disease, and that any care or recommendation I receive in this clinic or from my therapist is not a substitute for a physician’s care. I take responsibility for alerting my therapist of any changes to my health status, medications and therapies before the session, as well as any and all responses perceived to be a result of massage therapy as soon as I become aware of them. I understand that no sexual activity, comment or innuendo will be tolerated. In the event of this situation occurring, the treatment will be terminated immediately and no refund will be given. This facility reserves the right to refuse services at their discretion based upon the client’s conditions, therapist’s skill set, client attitude or action, etc, without explanation or prior notice, and I agree to this policy. Cancellation within 24 hours of scheduled massages may result in a charge of up to the full price of your intended session. You may contact me for appointment reminders, schedule changes, or other needs.