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 ...
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.
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
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.
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.
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 ...
Massage Therapy Waiver and ConsentForm. 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:.