Massage Consent

Please read the following carefully. Your signature indicates understanding and voluntary consent to receive massage therapy services.

Student Massage Therapist Acknowledgment

I understand that Alana Jensen is a student massage therapist in training, applying techniques learned through formal education. All services will be provided within the appropriate scope of practice for a student therapist. I agree to provide feedback during the session, including pressure preferences and any discomfort, so the experience can be adjusted for my comfort and well-being.

Massage Information

• Client understands it is a professional therapeutic massage performed by a Student Massage Therapist (SMT).

• Massage therapy is provided for relaxation, stress reduction, relief of muscular tension, and support of overall wellness.

• Massage therapy is not intended as a substitute for primary medical care or medical treatment.

• The SMT cannot diagnose medical conditions, prescribe medications, or order medical tests.

• No guarantees are made regarding relief of pain, tightness, inflammation, or other symptoms.

• Results vary from client to client and depend on individual conditions and consistency of care.

• Massage is provided as agreed upon by the therapist and client to support the client’s stated goals.

• Client understands massage therapy is not sexually oriented in any manner.

• Client may refuse, modify, or terminate the session at any time for any reason.

Benefits of Massage Therapy

• Reduced muscle tension and stiffness Improved circulation

• Enhanced relaxation and stress reduction Increased range of motion and flexibility

• Support for injury recovery

• Decreased anxiety and improved mood Improved sleep quality

• Enhanced body awareness

Possible Side Effects of Massage Therapy

• Temporary soreness

• Mild bruising

• Fatigue

• Increased urination

• Headache

• Emotional release

• Lightheadedness

Techniques & Treatments May Include, but are not limited to:

• Swedish massage

• Deep tissue massage

• Myofascial release

• Trigger point therapy

• Stretching techniques

• Range of motion techniques

• Cupping (if applicable)

• Hot/cold therapy (if applicable)

Contraindications

• Certain medical conditions may make massage inadvisable or require modification.

• Client agrees to disclose all known medical conditions and medications.

• Client understands massage may be contraindicated in cases including but not limited to: fever, infectious disease, blood clots, uncontrolled high blood pressure, recent surgery, fractures, or certain skin conditions.

• If there is any uncertainty regarding a medical condition, a physician’s written approval may be required before services are provided.

Nature of the Session

• A typical session lasts 60 minutes (unless otherwise scheduled).

• Extended sessions (75 or 90 minutes) may be available upon request.

• Client will disrobe to their level of comfort.

• Client will be professionally draped at all times, with only the area being worked on exposed.

• Proper draping techniques will be maintained throughout the session.

• Client will immediately inform the therapist of any discomfort during the massage.

• Client agrees to communicate preferences regarding pressure, temperature, music, and comfort.

Client Responsibilities

• Client agrees to provide accurate and complete health information on the intake form.

• Client agrees to notify the SMT of any changes in health status, medications, or medical conditions.

• Client agrees to inform the SMT immediately if pressure is too light or too deep.

• Client understands massage is designed to support wellness and is not a primary medical treatment.

• Client agrees to follow policies and procedures documented in the brochure and verbally communicated by the SMT.

Confidentiality & Privacy

• All client information is confidential and protected.

• The SMT abides by HIPAA guidelines and confidentiality standards.

• Client information will not be shared without written consent unless required by law.

• Client privacy will be maintained at all times.

Fees & Payment

• Massages are free until I receive my license. Tips are not required but appreciated.

Collaboration with Other Health Professionals

• With written consent, the SMT may collaborate with other healthcare providers to support client care. Referrals may be recommended when appropriate.

Consent

• Client understands massage therapy is voluntary.

• Client understands they may ask questions at any time.

• Client acknowledges understanding of the information above.

• Client understands that by signing this form, they give informed consent to receive massage therapy services.

• I release Calm Breath Wellness and its therapist from any liability for injury, discomfort, or damages that may result from massage therapy, except in cases of gross negligence.

By signing below, I acknowledge that I have read, understood, and agree to the terms of this waiver.