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Trusted Bodywork client consent form
Confidential client consent for deep tissue and holistic massage
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* Indicates required question
Email
*
Your email
First name
*
Your answer
Last name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Treatment date
*
MM
/
DD
/
YYYY
I confirm that I
*
Have had a thorough consultation with my chosen practitioner
Have been informed of the proposed treatment plan and agree to proceed with my therapist to address my specific needs
Understand that therapeutic massage is not a substitute for traditional medical treatment
Understand the importance of informing my massage therapist of all medical conditions and medication I am taking, and to let him know about any changes therin
Understand that there may be additional considerations based upon my physical, emotional and psychological condition
Understand that it is my responsibility to inform the therapist of any discomfort during the massage so he may adjust accordingly
Required
A copy of your responses will be emailed to the address you provided.
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