Consent Forms

Please ensure to complete both consent forms prior to appointment time to prevent the loss of time during your much deserved treatment.

*Therapeutic consent and Sensitive Area consent forms must be complete and signed prior to any treatment.

Therapeutic Massage Treatment Consent

I, the undersigned, consent to receive massage therapy treatments from Candace Scott, a Registered Massage Therapist (RMT) in Alberta, at Tetelestai Wholeness & Massage. I understand that the purpose of massage therapy is to promote relaxation, improve circulation, alleviate pain, and support physical and mental well-being. Massage therapy includes techniques such as Swedish massage, deep tissue work, trigger point therapy, myofascial release, stretching, and other therapeutic modalities. I understand that the results are not guaranteed. I further understand that I am informed, as in all health care, in the practice of the above-mentioned therapies that there may be side-effects(post-treatment soreness, redness, etc.) I wish to rely on the therapist to exercise judgement during my treatment plan. By signing below, I am agreeing to the above-names therapies. I acknowledge and agree to the following: Scope of Treatment I understand that massage therapy may include the manipulation of muscles, soft tissue, and fascia, stretching, therapeutic exercise, and some nutritional education, using techniques that may vary depending on my therapeutic needs. I am aware that the massage therapist will discuss the treatment plan and seek my feedback throughout the process. Potential Risks and Benefits I understand that while massage therapy is generally safe, there are potential risks, including bruising, soreness, and discomfort, which may arise from treatment. I also understand that pre-existing conditions may be aggravated, and I will immediately inform my therapist if I feel any discomfort during the session. I am aware that it is important for me to provide honest and open communication with my therapist during treatment, especially regarding any sensations or discomfort I may experience. I acknowledge that I have had the opportunity to ask questions and receive answers about my treatment and the techniques to be used. Right to Refuse Treatment I understand that I have the right to refuse or discontinue treatment at any time, and that my decision will not affect the care I receive in the future. I will immediately notify the therapist if I feel the need to stop the treatment. Client’s Responsibility and Consent By typing my name below and submitting this form, I consent to receiving massage therapy from [Therapist’s Name], and I agree to follow the therapist’s instructions and recommendations during the treatment. I understand that this consent is ongoing and applies to future treatments unless I provide written notice that I wish to withdraw it.

I give my informed consent to receive treatment with Candace Scott through Tetelestai Wholeness & Massage

Legal Name

First Name

Last Name

Date

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Signature

Electronic Signature Consent I acknowledge that my typed name will be treated as an electronic signature, and by submitting this consent form, I am agreeing to the terms outlined in this document.

Treatment Consent Form – Treatment of Sensitive Areas

I, hereby consent to receive massage therapy as discussed with my therapist prior to and during my treatment session. I understand that the purpose of this treatment is for relaxation, stress reduction, relief from muscular tension, spasm, or pain, or to improve circulation and energy flow.

First Name

Last Name

Treatment of Sensitive Areas:

I give consent for my Massage Therapist to work on the following sensitive areas indicated below (please initial)

Upper/inner thigh (adductors)

Buttocks (gluteal muscles)

Chest wall musculature/ Pectorals (not including breasts)

I also have the option to identify any other area I consider sensitive. I understand that these areas will only be treated with my explicit consent and in a manner that respects my comfort and boundaries. My therapist has explained draping procedures to me prior to treatment. I understand that at any time before or during the treatment, I have the right to withdraw my consent for treatment of any area, including the sensitive areas mentioned above, without the need to provide any reason. I also acknowledge that my therapist has the right to refuse treatment to any area they deem inappropriate or outside their professional scope.

Signature:

By signing below, I confirm that I have read and understood this Informed Consent document. I have had the opportunity to ask questions, and any questions I have asked have been answered to my satisfaction. I agree to proceed with the massage therapy under the terms outlined above.Electronic Signature Consent I acknowledge that my typed name will be treated as an electronic signature, and by submitting this consent form, I am agreeing to the terms outlined in this document.

I give my informed consent to receive treatment of sensitive areas from the therapist named in this form.

Date

MM

DD

YYYY

Therapist Name: Candace Scott Therapist Signature: 𝒞𝒶𝓃𝒹𝒶𝒸𝑒 𝒮𝒸𝑜𝓉𝓉