THE BRIGHT PHYSIO & MINDFULNESS MASSAGE INC.
    Unit 105, 4904 30 Avenue, Beaumont, AB T4X 3G3 | Phone: 780-737-1019 | Fax: 844-777-1796
    Email: info@thebrightphysio.ca | Website: www.thebrightphysio.ca
    MASSAGE THERAPY ASSESSMENT & TREATMENT CONSENT FORM
    Massage Therapy
    Please read this form carefully before receiving massage therapy. All personal and health information provided to
    the clinic will be handled confidentially and in accordance with applicable privacy requirements.
    I understand that the massage therapy I receive may be provided for purposes including relaxation, reduction of
    muscular tension, pain management, improved mobility and general wellness, within the scope of practice of the
    massage therapist.
    I understand that I should communicate with my massage therapist throughout the session. If I experience pain,
    discomfort, dizziness, numbness, unusual symptoms, or if the pressure or technique is uncomfortable, I will inform
    the therapist immediately so that the treatment can be adjusted or stopped.
    I understand that massage therapy is not a substitute for appropriate medical assessment, diagnosis, or treatment
    by a physician or other regulated healthcare professional when such care is required.
    I understand that a massage therapist does not perform spinal or skeletal adjustments and does not diagnose
    medical conditions, prescribe medication, or provide treatment outside the therapist's professional scope. If
    appropriate, the therapist may recommend that I consult another healthcare professional.
    I understand that there may be temporary effects following massage therapy, such as tenderness, soreness,
    fatigue, light-headedness, or temporary changes in symptoms. I agree to inform the therapist of any relevant health
    conditions, injuries, medications, allergies, pregnancy, recent surgery, or changes in my health that may affect the
    safety or suitability of treatment.
    I understand that the massage therapist may modify, postpone, refuse, or stop treatment if, in the therapist's
    professional judgment, massage therapy is not appropriate or may be contraindicated.
    I understand that professional boundaries must be respected at all times. Any sexually suggestive, inappropriate,
    threatening, abusive, or harassing remarks or behaviour may result in the immediate termination of the session
    and may result in refusal of future services.
    I understand that I may ask questions about the proposed assessment or treatment at any time, may request
    changes to the treatment, and may withdraw my consent or stop the session at any time.
    By signing below, I confirm that I have read and understood the information above, have had an opportunity to ask
    questions, and voluntarily consent to massage therapy assessment and treatment at The Bright Physio &
    Mindfulness Massage Inc.