• - Client Consent and Intake Form for Bodywork and Massage Treatments
    Client Consent and Intake Form for Bodywork and Massage Treatments ... I have received the policy statement, and have read and agree to the policies therein.
  • - Massage Client Waiver Form - Therapeutic Massage in Avondale
    ______ By signing this release, I hereby waive and release my therapist from ... ______ I have received the policy statement, and have read and agree to the ...
  • - Massage Client Intake and Consent Form - Nutrition Plus
    Massage Information. Please take a moment to carefully answer the following questions. If you have a specific medical condition or specific symptoms, massage.
  • - Massage Therapy Informed Consent: Please read the following ...
    Massage Therapy Informed Consent: ... Needs assessment and treatment plan including client health history form, assessment and examination procedures,.
  • - Client Intake Form – Therapeutic Massage - Advanced Holistic Health
    Clients under the age of 17 must be accompanied by a parent or legal guardian during the entire ... Massage Patient Information & Informed Consent Form. 1.
  • - client intake form - American Massage Therapy Association
    If yes, what types of massage have you had (swedish, shiatsu, deep tissue, .... Medical Records with your attorney that may impact the above release statement.
  • - Massage Therapy Consent Form - Therapeutic Touch
    Massage Therapy Consent Form. Please read ... that massage should not be construed as a substitute for medical examination ... Client's Personal Details: ...
  • - Informed Consent Form - Association of Massage Therapists
    massage therapy informed consent. I, (Client's Name) have chosen to consult with and hereby give consent for massage therapy to be provided by (Therapist's ...
  • - Client Intake Form
    medical condition or specific symptoms, massage/bodywork may be contraindicated. ... I understand that the massage/bodywork I receive is provided for the basic ... Consent to Treatment of Minor: By my signature below, I hereby authorize ...
  • - MASSAGE THERAPY Informed Consent Form
    Informed Consent Form. This record of consent is required before the first assessment or treatment and will be maintained confidentially in the client file.
  • - massage client intake and release of liability form - Massage Green SPA
    DISCLAIMER: This place of business is not responsible for lost or stolen property, nor will this place of business be held liable for any injury or condition that ...
  • - Massage Therapy Registration and Consent Form - Adventist Health
    IMPORTANT: Please read each statement carefully and sign below ... I give consent to receive massage therapy and agree to pay the fee upon completion of this service. As a ... accordingly between client and Wellness department personnel.
  • - Minor Consent Form - Ultimate Wellness Massage LLC
    History Form for the minor, along with consent for the massage therapy session. Guidelines: ▫ Minors (all clients under the age of 18 – unless otherwise.
  • - Masage Intake Form _2017 - Kawartha Care Wellness Centre
    The information gathered through your health history provides your massage ... will be kept confidential unless you submit a written request for us to release your ...
  • - Oncology Massage Intake Form
    Oncology Massage New Patient Form. Name: Date of Birth: Address: ... of the date of the massage session, it may be necessary to have your physician complete the MD permission form. 5. ... Liver or Kidney conditions (for example: kidney failure ... 24. Arthritis or Joint problems. 25. Digestive
  • - Massage Therapy Client Agreement & Health Release Form
    I authorize the release of my medical records from Bodies in Balance Physical. Therapy in order to help plan a safe and effective massage therapy session. Client Agreement: It is my choice to ... STATEMENT. Printed Name. Signature. Date.
  • - Health Information form - ABMP
    Client Name: ... Is this massage/bodywork medically necessary (is it for a medical condition, injury, surgery)? Yes ... Yes ☐ No ☐ If yes, please complete the Billing Information form. ... Understanding all of this, I give my consent to receive care.
  • - Student Massage Clinic - Body Therapy Institute
    PURPOSE: This Clinic is part of the Massage Therapy Diploma Program at BTI. ... own Client Consent Form and Health Questionnaire before arriving for the ...
  • - informed consent to treatment - Alliance Physio
    statement and agree to treatment based on this document. I consent to massage therapy treatments provided by an RMT at Alliance Physio. Client Name(Print).
  • - 1 CLIENT INFORMATION AND CONSENT FORM FYI: an accurate ...
    CLIENT INFORMATION AND CONSENT FORM. FYI: an accurate health history ensures that it is safe for you to receive a massage treatment, and helps the ...
  • - Pediatric Client Intake Form - Child of Peace Massage
    Pediatric Client Intake Form ... (example: yoga therapy, cranial sacral therapy, bioaquatic therapy) □ Yes □ No ... Pediatric Massage | Consent Form. Massage ...
  • - New Client Intake Form - Elements Massage
    Elements Massage™ studio's privacy and security policy. (initial here) .... A statement that if the client is uncomfortable for any reason, the client may ask the ... I consent: Draping will be used during the session, unless otherwise agreed to by ...
  • - Subsequent Visit Case History/Treatment Form - NSW School of ...
    Subsequent Visit Case History/Treatment Form. Date. Massage Treatment Log # ______. Time. Client's ... Client Consent & Signature. This is to confirm and ...
  • - Initial Visit Case History/Treatment Form - NSW School of Massage
    Initial Visit Case History/Treatment Form ... Client's Personal Information ... student massage therapist and have the right to withdraw consent at any time.
  • - Massage Therapy Waiver and Consent Form - Perfect Patients
    Massage Therapy Waiver and Consent Form. Thank you for choosing Natural Wellness Centre for your massage therapy! It is our goal to provide you ... (Example: dates, areas of disorder/disease, type, symptoms of ... Signature of Client: Date:.
  • - Health History Form Template - Zardus Art of Massage and Wellness ...
    CLIENT HISTORY INFORMATION. Zardus Art ... Have you had professional massage before? ... CONSENT TO TREATMENT OF MINOR: I hereby authorize the ...
  • - Massage Client Intake Form - PatientPop
    Massage Client Intake Form. Date: ______. Name: ... (Example: Reduce pain, Reduce stress, etc.) Have you ever experienced a professional massage/bodywork session? ___ Yes ___ No ... Massage Therapy Informed Consent. I understand ...
  • - Massage Works - muskoka massage therapy
    Consent to Treatment Form ... to the client. For example, health history and ... personal information of clients, including a complete health history, medical.
  • - Pregnancy Massage Client Intake Form
    Pregnancy Massage Client Intake Form. 1 ... Have you received Massage Therapy or Bodywork before? ... May I have permission to contact your Care Provider?
  • - Oncology Massage Consent form Updated 10.30.17 - Thrive Wellness ...
    massage therapy does not substitute for medical examination or treatment. Because ... By signing this form, client's attending physician acknowledges receipt of ...


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