The following information will be used to help plan safe and effective massage sessions. Please answer the questions to the best of your knowledge. Please be advised: If under the care of a doctor for medical conditions that may be contraindication you must need to obtain a script from your Doctor stating your ability to receive a massage.
Consent for Treatment
Massage and Bodywork Therapy practices are designed to promote and maintain the health and wellbeing of the client.
I understand that a massage therapist does not diagnose disease, illness, or prescribe any treatment or drug, nor do they provide spinal manipulation. I understand that draping will be used at all times and that breast massage will not be administered on female clients. I understand that if I become uncomfortable for any reason that I may ask the therapist to end the massage session, and they will end the session. I understand that the massage Therapist may end the session for any inappropriate behavior. I understand my massage may include various modalities included but not limited to deep tissue, myofascial release, cupping, stretching, aromatherapy, hot stone, Himalayan hot stone, cold stone, gua sha, basic vibrational therapy using tuning forks, frequency therapy, crystal therapy, meditation, visualization and breathwork. Because massage and bodywork therapy may be contraindicated due to certain medical conditions, I affirm that I have informed the therapist of all my known medical conditions and will keep the therapist updated as to my changes in my medical condition.
I hereby declare and certify that I take part of the massage therapy my own responsibility. I declare that I am an adult without a disease (eg heart disease, pacemaker, etc), which would be dangerous for me to have a massage. I informed the therapist about all my health problems. I understand that Carrie Villanueva is not responsible for the potential problems with me during or after the treatment. With my present statement I irrevocably sign away claiming any damages against Carrie Villanueva and Live Whole Massage & Holistics, LLC.
