Minor Massage Policy

Massage service offered at this practice is for the purpose of general wellness, stress reduction, and relief of muscular tension.

I (parent or guardian) must remain at this massage office for the duration of the minor's massage session.

I may remain in the treatment room throughout the treatment. I (parent or guardian), the patient, or the massage therapist may terminate the session at any time.

The patient does not have any injuries or conditions that prevent receiving massage therapy.

I understand the importance of informing the massage therapist of all medical conditions and medications that the patient is taking, and that there may be additional risks based on the patient's physical or mental conditions.The patient must immediately inform the therapist of any pain or discomfort so that the pressure or techniques used can be adjusted to remain within comfort limits.

The massage therapist is not responsible for any pain or discomfort experienced during or after the treatment.

I have been given the opportunity to ask questions about massage therapy and my questions have been answered. Also, I have been advised of the policies and procedures pertaining to massage and I understand these policies.

As the parent or guardian, I understand and consent to the following:

• Information regarding massage in general, benefits, risks, contraindications of massage, and possible alternative therapies have been explained to me. I further understand that massage therapy is not a substitute for a medical examination or treatment, and that I should see a physician or other qualified health specialist
  for any mental or physical ailment of which I am aware.
• I understand that massage therapists do not diagnose illness or disease, and nothing said during the massage should be construed as such.
• My consent is informed and voluntary and I understand that I may withdraw my consent at any time except for actions already taken.

By agreeing and signing below, you acknowledge that you are the parent or legal guardian of the minor who is to receive massage or bodywork at this facility. You acknowledge that you have have read and understood all information on this form, and authorize this massage practice to provide therapeutic massage and bodywork for your child or dependent.