Please read this before your visit. Syreeta will go over your session plan with you in person and countersign your consent then.
Massage therapy involves hands-on work with soft tissues and may include pressure, movement, and gentle stretching within my comfort and the therapist’s training. The therapist will discuss the session plan, pressure, areas to be worked, and any relevant precautions with me.
I understand that massage is not a medical diagnosis or a substitute for medical care. Results vary. I have provided relevant health information and will tell the therapist about new symptoms, illness, injury, pregnancy, medications, allergies, or discomfort before or during a session.
I choose which areas may be worked. Appropriate draping and privacy will be provided while I change and during the session. Genital areas will not be massaged. Breast tissue work is outside this general consent and requires separate written consent and qualifying training. I may ask to change pressure, skip an area, pause, or end the session at any time, including after I sign this form. The therapist may modify, postpone, or stop a session when appropriate.
Possible temporary responses can include tenderness, fatigue, or lightheadedness. I will promptly report unexpected pain, dizziness, numbness, or other concerning symptoms. No particular result has been promised.
I have had an opportunity to ask questions and voluntarily consent to the massage plan discussed today. This consent does not take away my right to request an immediate change or end the session.
Parent or guardian consent for a minor The date of birth above shows the client is under 18, so a parent or legal guardian must complete and sign this part.
Parent or legal guardian * Relationship * Phone *
I am the minor’s parent or legal guardian and authorize massage therapy for the minor named above. I have reviewed the health history and informed consent, discussed the proposed session and boundaries, and had an opportunity to ask questions. I understand the minor may request a change or stop at any time; the therapist will honor that request.
Areas or techniques excluded, pressure limits, or other instructions
Guardian presence preference In room Nearby and available Discuss with therapist
Minor assent, if able (minor types their name)
I am the parent or legal guardian and give consent for this minor’s massage session. * 