Informed and Voluntary Consent Form "Massage"

Massage Therapy is a manipulation of the soft tissues of the body, including the skin, tendons, muscles and connective tissue by a professional for relaxation, to decrease pain, to increase range of motion, and to enhance the body's own healing capability.

I understand it is necessary for the massage and bodywork therapist to touch and observe my body in order to conduct this process.

I am aware that this work is performed directly on the skin.

I understand that proper draping techniques will be maitained at all times.

I acknowledge that I need to tell the therapist if the pressure or strokes are too hard to cause pain.

I understand that the treatment can be stopped at any time.

I have informed the massage therapist of all my known physical conditions, medical conditions and medications, and I will keep the massage therapist updated of any changes.

I understand that massage therapy is not intended as a substitute for a medical examination and is not designed to diagnose a medical condition, offer a medical treatment or prescribe medication.

I waive any claim against Back In Motion Intergrative Therapy and the therapist, and assume all risks of injuries that may result.

I give Back In Motion Integrative Therapy and the therapist my permission and consent to do all those things necessary in helping me achieve a pain free and active lifestyle, including but not limited to touching my body.

I give the therapist full privilege and license to work on my body in such a way.



Signature:_______________________________________ Date:________________________________


Printed Name:________________________________________________________________________________

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