Informed Consent

Thank you for reviewing the Touch Fitness Informed Consent Page! Please print this page, sign at the bottom and bring it to your first appointment. 

It is my choice, as a client, to receive massage therapy with Sherrin Bernstein and/or any of her employees or representatives at Touch Fitness, Informative Bodywork. I understand that bodywork and massage therapy given here is for the purpose of body/mind/spirit awareness and integration, stress reduction, relief from muscular tension or spasm, for increasing circulation and energy flow and to assist in the body healing itself. If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that pressure or strokes may be adjusted to my level of comfort.

I understand that it is not within the scope of practice of a licensed massage therapist to diagnose illness, disease or any other physical or mental disorder; nor do they prescribe medical treatment of any kind. I acknowledge that massage is not a substitute for medical examination, diagnosis or treatment, and that it is recommended that I see a Licensed Medical Doctor or Doctor of Chiropractic for services which are beyond the scope of practice of a licensed massage therapist.

I understand that massage/bodywork practitioners are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of a session should be considered as such.

Because massage/bodywork should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and have answered all questions honestly. I agree to take it upon myself to keep the massage therapist updated on my health and wellbeing and I understand that there shall be no liability on the practitioner’s or company’s part should I fail to do so.

I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the massage, and I will be liable for payment for the full time scheduled.

I understand that I am responsible for my health and my commitment to my health and for paying the full agreed upon price of my service for any appointment cancellation made with less than 24 hours notice. Furthermore, I understand late arrivals are responsible for the fee of the entire session and any make up time provided is at the sole discretion of Touch Fitness and its practitioners.

I understand that, because massage therapy work involves maintained touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19. I acknowledge that I am aware of the risks involved from receiving treatment at this time, I voluntarily agree to assume those risks, and I release and hold harmless the practitioner/business from any claims related thereto. I give my consent to receive treatment from this practitioner.

_______________________________________________(Printed name)

_______________________________________________(Signature)

_______________________________________________(Date).

 

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