Massage & Bodywork

January | February 2014

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INFORMED CONSENT SAMPLE FORM The following details the kind of information you may want to include in your practice's Informed Consent Form. Welcome to Any Massage Clinic Massage Defined Massage can be defined as structured, professional touch. Massage techniques manually manipulate the muscles, tendons, and fascia of the body to promote health and wellness. Benefits of massage include stress reduction, circulation enhancement, increased relaxation, and relief from muscular tension, soreness, and pain. People may find that meditation, as well as other bodywork systems like myofascial release and energetic bodywork, provides results similar to relaxation massage. Limitations of Massage Massage therapists do not diagnose medical diseases or musculoskeletal conditions and massage is not a substitute for medical examination and treatment. Massage therapists do not prescribe herbs or drugs, including aspirin or ibuprofen, or medical treatments. They do not perform spinal adjustments and they cannot counsel clients about emotional or spiritual issues as would be provided by a mental health professional or spiritual leader. If you experience symptoms that lead you to believe you may have a medical condition, it is recommended that you visit a physician for diagnosis and treatment. For a detailed description of the massage scope of practice in this state, please visit the Board of Massage website at www.anyboard.com. Adverse Reactions to Massage Massage may lead to adverse reactions in certain situations or when used with certain conditions or medications. The massage therapist will evaluate your health-history intake and ask you questions to make sure it is safe for you to receive massage. In the event the massage therapist is uncertain that massage will be of benefit to you, he or she may ask you to provide a note from your physician stating that it is safe for you to receive massage. Please provide complete details of medical conditions and medications to your massage therapist during the health-intake interview. Failure to inform the massage therapist of all medical conditions and medications may place you at increased risk for adverse reactions. Any Massage Clinic and You Therapist Training and Experience All of the massage therapists working at Any Massage Clinic have completed a minimum of 500 hours of massage training from a state-approved school and passed the state licensing requirements. Therapists at Any Massage Clinic are knowledgeable in Swedish massage, and deeptissue and myofascial release techniques, as well as hydrotherapy. We also have therapists who specialize in prenatal massage, reflexology, spa body treatments, and craniosacral therapy. Pick up a menu of services from our receptionist to learn more about these forms of bodywork. Please ask us for a copy of our preferred provider list in the event we can't meet your particular needs. Business Policies and Practices You may book a 30-minute ($40), 60-minute ($80), or 90-minute ($120) session. Any Massage Clinic accepts cash, personal checks, and all major credit cards. We do not bill insurance companies for services. Plan to arrive 10 minutes early to update your paperwork and discuss any changes to your condition with your massage therapist. The first session usually requires a longer health intake process, so new clients should arrive 20 minutes early on their initial visit. Clients arriving late will be charged for the full session and the session will end promptly at the scheduled time. Clients must cancel sessions with 24 hours notice or pay for the missed session in full. Returned checks will It pays to be ABMP Certified: www.abmp.com/go/certifiedcentral 41

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