MASSAGE

Thank you for booking into a Healthworks Seated Massage. Please read and complete the following questionnaire and sign the form below.
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Full Name
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Please answer the following COVID-19 related questions below:

 


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Do you have any symptoms such as fever, cough, sore throat, runny nose, shortness of breath or fatigue?
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Have you been in contact with anyone who has been unwell with respiratory symptoms, fever or a suspected or confirmed case of COVID-19 in the past 7 days?
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Please answer the following massage related questions below:

 


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Is this your first massage?
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What is your preferred massage pressure?
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Note that the maximum massage chair safe weight limit is 110kg.
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PARTICIPATION CONSENT
I hereby give consent for massage therapy. I have provided my medical history. I do not expect the therapist to have foreseen any previous or pre-existing condition that I have not mentioned.

I understand that massage may provide benefits for certain conditions but results are not guaranteed. These benefits may include relief of muscular tension, relaxation, reduction in the symptoms of stress-related conditions and provision of general wellbeing. I also understand that massage therapy may produce side effects such as muscle soreness, mild bruising, increased awareness of areas of pain and light-headedness amongst other possible temporary outcomes.

I am aware that the therapist does not diagnose illnesses, prescribe medications nor physically manipulate the spine or its immediate articulations.

I will tell the therapist about any discomfort I may experience during the massage session and understand that the massage will be adjusted accordingly.
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Date
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