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Informed Consent Agreement

An informed consent agreement provides an opportunity for you to convey in writing what the client should expect from a massage therapy session with you. It also states the limitations of what the client should expect. The information enables the client to choose whether or not to receive the services you provide, and acts as a safeguard in the event liability issues arise during or after the service is provided.

Information Included

The following information may be included on the informed consent agreement:

  • Description of your approach to massage, modality and techniques
  • Benefits, limitations and contraindications of massage
  • Possible outcomes (this should not imply any guaranteed outcome)
  • The nature of a session, including the process of disrobing and draping
  • Your credentials and areas of expertise
  • Scope of practice what you can and cannot do based on your credentials
  • Statement that you will maintain client confidentiality and privacy
  • Session duration and fees
  • Policies for cancellations and late arrival
  • Insurance reimbursement capabilities, if any
  • Availability and hours of operation
  • Collaboration with other health professionals

Use with Client Intake Form

The informed consent form is almost always used in conjunction with the client intake form, which the client completes on his or her first visit. In the client intake form, the client provides information regarding his or her health history. Essentially, the client intake form says, here’s all about me, and then in the informed consent agreement says, I understand what your services are, and I agree to receive them.

A Simplified Informed Consent Agreement

I understand that the massage given to me by _______ is for the purpose of (stress reduction, pain reduction, relief from muscle tension, increasing circulation, or specific reasons stated here).


I understand that the massage therapist does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage therapy.


I understand that massage therapy is not a substitute for medical care and that it is recommended that I work with my primary caregiver for any condition I may have.


I have stated all my known physical conditions and medications, and I will keep the massage therapist updated on any changes.

 

[Client signature and date]

 

Tags: client experience, informed consent, risk management

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