The Massage Consent Form Template UK is provided in multiple formats, including PDF, Word, and Google Docs, featuring editable and printable versions for your convenience.
Massage Consent Form Template UK Editable – PrintableSample
Massage Consent Form Template UK 1. Client Information 2. Service Provider Information 3. Treatment Details 4. Medical History Disclosure 5. Consent to Treatment 6. Acknowledgment of Risks 7. Cancellation Policy 8. Payment Terms 9. Client Responsibilities 10. Therapist Responsibilities 11. Emergency Contact Information 12. Declaration and Signatures
PDF
WORD
Examples
[Client’s Name]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Therapist’s Name]
[Therapist’s Qualifications]
[Therapist’s Address]
This consent form is designed to inform you about the massage services provided and to obtain your consent for treatment.
The purpose of this massage therapy session is to address your specific concerns and promote overall well-being through relaxation and therapeutic techniques.
The types of massage therapies offered include, but are not limited to: Swedish massage, deep tissue massage, sports massage, and aromatherapy.
Please indicate which type you would like: [Checkbox or options to select].
Please list any medical conditions, allergies, or medications that the therapist should be aware of: [Text box or space for the client to fill in].
I understand that massage therapy is intended to promote relaxation and wellness, but it is not a substitute for medical treatment. I have provided an accurate health history and consent to receive massage therapy services. I can withdraw my consent at any time.
By signing below, I acknowledge that I have read and understood this consent form.
[Signature of the Client]
[Name of the Client]
[Signature of the Therapist]
[Name of the Therapist]
[Client’s Name]
[Client’s Address]
[Client’s Phone]
[Client’s Email]
[Therapist’s Name]
[Therapist’s Qualifications]
[Therapist’s License Number]
This session is intended to provide therapeutic touch and relaxation. Please disclose any specific areas of tension or concerns you might have.
I consent to receive massage therapy and understand that all treatments are customized to meet my individual needs and preferences.
I understand that I can discuss any aspect of the treatment with the therapist, and I can stop the treatment at any time.
I acknowledge that there are inherent risks associated with massage therapy and that I have had the opportunity to ask questions regarding these risks and treatment options.
I understand that my health information is confidential and will not be shared without my consent, except as required by law.
[Signature of the Client]
[Name of the Client]
[Signature of the Therapist]
[Name of the Therapist]
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