Issue link: https://www.massageandbodyworkdigital.com/i/230373
VISIT WWW.ABMP.COM TO DOWNLOAD A VARIETY OF CLIENT FORMS, INCLUDING THESE: HEALTH INFORMATION, HEALTH STATUS UPDATE, OFFICE POLICIES, SCREENING QUESTIONNAIRE. Informed Consent I, (client's name) –––––––––––––––––––––––––– have read and understand the disclosures, policies, and procedures of Any Massage Clinic, and I would like to receive a massage session or request a session for my child or dependent. I understand the benefits and limits of massage therapy and understand massage may cause adverse reactions in certain situations. If I experience any discomfort during the session, I will immediately inform my therapist so he or she can modify the massage strokes. I understand massage therapists do not diagnose diseases or conditions, prescribe medications or treatments, or perform spinal adjustments. I recognize massage is not a substitute for medical treatment and should I need medical treatment, I will seek out the appropriate health-care professional (physician, psychotherapist, chiropractor, etc.). I understand that it is my responsibility to keep the massage therapist informed of changes in my (or my child's or dependent's) health status, diagnosed medical conditions, and medication. I understand that failure to inform the therapist of these changes may place me (or my child or dependent) at greater risk of adverse reactions to massage. I release the massage therapist of any liability if I fail to disclose the appropriate health-related information. Client's Signature:________________________ Date:___________________________________ Therapist's Signature:____________________ Date:___________________________________ I authorize the therapists of Any Massage Clinic to provide massage to my child or dependent:_____________________________ Name of Child or Dependent:______________ _______________________________________ Parent or Guardian Signature:_____________ Date:___________________________________ suggestions of alternate therapies that have benefits similar to massage. • A written and verbal description of the massage scope of practice in the relevant state, or directions to the website where the client can read the massage scope of practice, and the contact details for reporting therapist misconduct. • A written and verbal description of the therapist's training, credentials and experience, and disclosure of any factors that limit the therapist's professional ability such as hearing disorders, vision impairment, or lack of experience in a particular relevant area (e.g., the client is pregnant and the therapist has never before given a prenatal massage). • A written and verbal description of business policies relating to the professional relationship between the client and therapist. This would include the fee schedule, hours of operation, returned check policy, late arrival or noshow policy, policy on draping, sanitation protocols, and expectations on the client's conduct. For example, "The client is expected to demonstrate good hygiene and not use illegal drugs or alcohol before a session." • A written and verbal description of activities or behaviors that constitute sexual impropriety and the consequences of such behaviors (i.e. termination of the session, report to the police). • A written and verbal description of the rights of the client including the right to terminate the session at any time, confidentiality, and the limits of confidentiality. Informed consent procedures benefit both the client and the therapist because they clarify the expectations of both parties and provide guidelines for how sessions are conducted. Informed consent establishes the framework of the therapeutic relationship. This empowers the client to feel in charge of his session and supports therapists in setting good boundaries with clients. Anne Williams is the director of education for Associated Bodywork & Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012), from which this article was adapted, and Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams & Wilkins, 2006). She can be reached at anne@abmp.com. It pays to be ABMP Certified: www.abmp.com/go/certifiedcentral 43