Consent for Treatment

I agree to disclose to the therapist or Instructor prior to any treatment, any health conditions from which I suffer, including but not limited to those listed on the client intake form.

I understand that:

  • This is a massage, yoga or pilates session and is not a medical or allied health treatment (physiotherapy osteopathy, chiropractic)
  • I have viewed the therapists’ or Instructors qualifications
  • The risks specific to my individual circumstances may have a bearing on my decision to proceed with the proposed treatment or session
  • The therapist or Instructor reviewed my health history before treatment commenced
  • The therapist or Instructor explained that the physical assessment I received may involve partial undressing and may require the therapist to palpate (touch) the area(s) of my body relevant to my presenting condition
  • The therapist or Instructor explained the treatment or session outline to me
  • The therapist or Instructor explained the associated risk and possible side effects with the treatment or session options as described
  • In relation to a massage session- The therapist discussed the massage procedures, the areas of the body to be treated, undressing and dressing procedures, the draping procedures and the positioning on the table for and during treatment
  • The therapist or Instructor established that the treatment or session will be stopped should the treatment or session as first agreed to, require modification. The therapist or Instructor will explain the reason for the change and any risks and/or side effects as a result of the change
  • I can ask any questions in regard to any modification to the treatment plan. I should be totally comfortable with the explanation and reasoning for the change before consenting to the modification to the initial treatment plan
  • The therapist or Instructor has explained that I have the right to refuse treatment, to make changes to the treatment and to stop the massage or session at any time
  • In relation to massage- I have the right to request evidence for treatment that may include the abdomen, anterior and lateral chest, and buttock and / or groin areas. I understand I have the right to refuse treatment of these areas.
  • In relation to yoga and Pilates – I will disclose any pain or discomfort experienced during my session.

By agreeing to this consent form I also agree to join the Kavanah Care mailing list