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 (LMT).
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:
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
Collaboration with Other Health Professionals
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.
