It is my choice to receive massage therapy.  I am aware of the benefits and risks of massage and give my consent for massage.  I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments.  I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis.  I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status.

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I understand that my personal health information will be collected.  I understand that all information that I provide will be kept confidential unless required by law.  I understand and consent that my medical information may be shared by the various care providers involved in my care and treatment.

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Treatments may be covered by extended health care plans.  I understand that it is my responsibility to confirm the exact details of my coverage.