Brazilian Lymphatic Drainage Intake/Consent

Required Field

The Brazilian Lymphatic Drainage Massage is a hybrid between aesthetic body sculpting and massage therapy.  While areas of focus and pressure can be customized to your goals and comfort level, there is a specific sequence and rhythm for this treatment.  Time will primarily be spent on the abdomen, with firm pressure within your tolerance.  Additional neck work and the backs of the legs are included in 90 minute sessions only.  If you would like your treatment to also focus on muscle tension or include other areas, you may add on a 30 or 60 minute "Signature Massage."

Personal Info
Contact Info
Emergency Contact
Medications
Health History/Conditions
Area of Complaint
Headaches
Neurological
Cardiovascular
Reproductive
Immune
Musculoskeletal
Gastrointestinal
Blood
Skin
Respiratory
Hearing
Kidney
Endocrine
Miscellaneous
Tell me more.
Have you had any surgeries, injuries, or auto accidents either within the past 12 months, or that are relevant to how you are feeling today?
Use of oil, firming cream, and/or aromatherapy

This treatment requires lubrication for flowing movements and I primarily use unscented jojoba oil.  I am a massage therapist, not an esthetician, and it is out of my scope of practice to diagnose skin conditions or offer skincare advice.  Beginning the treatment, if desired, I do apply a firming cream may aid in the aesthetic benefit of your treatment.  This cream contains retinol.  Additionally, I may incorporate occasional use of essential oils, candles, etc.  Please note if you have any allergies, skin sensitivities, or simply do not like certain scents or products.  

What are your goals for receiving this treatment? Select all that apply.
Is there anything you need for additional comfort/support during your session?
Before and After Photos

If your session is for aesthetic purposes, I highly recommend taking before and after photos to measure visible difference.  This is not required, and your privacy is of upmost importance to me.  By consenting to photo sharing, you will be helping others know what to expect from this treatment.  Photos are taken of the abdomen only, and identifying features such as tattoos may be blurred or removed upon request.  

Review & Agree