Massage Therapy Informed Consent (Breast / Chest & Glute Treatment)

Required Field

Purpose of Treatment

I understand that massage therapy provided by Yaima Massage & Movement is performed for therapeutic purposes only, including pain relief, injury recovery, postural support, movement improvement, and functional performance.

Certain conditions may require treatment of sensitive areas such as the chest/breast region or gluteal muscles when clinically appropriate.

Breast / Chest Area Treatment (Therapeutic Only)

I understand that therapeutic treatment of the chest/breast area may be indicated for medical or functional reasons such as postural dysfunction, shoulder or neck conditions, scar tissue, lymphatic drainage, or movement restriction.

  • Treatment will be performed only with my informed consent

  • Proper draping will be maintained at all times

  • Only the specific area being treated will be exposed

  • Breast/chest treatment is never performed for relaxation or non-clinical purposes

  • I may request modification or stop treatment at any time

    • The gluteal cleft and genital areas will always remain covered

    • Treatment is strictly professional and therapeutic

    • I may request modification or stop treatment at any time

Gluteal Muscle Treatment

I understand that the gluteal muscles are a major muscle group commonly treated for low back pain, hip dysfunction, gait issues, and sports-related conditions.

  • The gluteal cleft and genital areas will always remain covered

  • Treatment is strictly professional and therapeutic

  • I may request modification or stop treatment at any time

Massage Therapy Informed Consent (Breast / Chest & Glute Treatment)

Client Rights & Communication

  • I understand I may withdraw consent at any time, verbally or non-verbally

  • I agree to communicate discomfort, concerns, or questions immediately

  • I understand that any inappropriate behavior or sexualized conduct will result in immediate termination of the session

Personal Info