Manual Therapy & Body
Treatment Consent Form
Please complete your health history, review the treatment instructions, and fill in the required acknowledgment and signature fields.
Client Information
Health History
Health conditions or concerns:
Contraindications & Treatment Limitations
I understand that treatment may be modified, postponed, or refused based on my condition.
General contraindications: Treatment will not be performed in cases of fever, infectious diseases, acute inflammation, open wounds, bruises, or severe undiagnosed pain.
MYOFASCIAL RELEASE (MFR)
Please indicate the areas where you feel pain, tension, tightness, or discomfort.
MFR: Affected Areas
LYMPHATIC DRAINAGE (MLD)
Please indicate the areas where you feel swelling, heaviness, or discomfort.
MLD: Affected Areas
Client Requirements & Responsibility
Preparation: I confirm that I have not consumed alcohol in the past 24 hours, I am hydrated, and I am wearing appropriate clothing.
Medical Disclosure: I confirm that I have fully and truthfully disclosed my complete medical and health history, and that I have informed the practitioner of any medical conditions, medications, allergies, or ongoing treatments.
Post-Treatment: I am responsible for following aftercare instructions, monitoring my body's response, and seeking medical guidance if unusual symptoms arise. Failure to follow instructions may increase the risk of adverse effects.