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Intake and Consent form

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Please read the following statement of consent.

It is my choice to receive bodywork. I realise that the treatment is being given for the well-being of my body and mind.  This includes stress reduction, relief from muscular tension, spasm/pain and improving circulation.  I agree to communicate with my practitioner anytime I feel like my well-being is compromised. 


I understand and am informed that in the modalities practiced there are some possible physical and emotional  side effects that may occur.  I do not expect the therapist to be able to anticipate and explain all the risks and complications.  I rely on the therapist to exercise their best judgment during the course of the session, which they feel at the time, based upon the facts that they know, is in my best interest.  I further understand results are not guaranteed.


I understand that the practitioner does not diagnose illness, disease or any other physical or mental disorders, nor do they prescribe medical treatment or pharmaceuticals.   I acknowledge that these modalities are not a substitute for medical examination or diagnosis, and that it is recommended that I see a primary health care provider for that service.  I have stated all medical conditions that I am aware of and will update my practitioner of any changes in my health status.


I have read the above consent.  By clicking below I have agreed to the included procedures.  I intend this consent form to cover any future treatments I receive from this practice and am aware I can remove consent at any point.

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