ALFA THERAPY LLC Massage Therapy, Assisted Stretching, and Bodywork Consent Form
Purpose of Services
Massage therapy and bodywork are hands-on practices intended to support muscle tension relief, mobility, pain management, and functional movement. Services at Alfa Therapy LLC may include massage therapy, assisted stretching, mobility coaching, fascial release techniques, compression techniques, and movement-based bodywork intended to support pain management, mobility, and functional movement. These services are not a substitute for medical care, diagnosis, or treatment. Practitioners do not perform medical examinations or prescribe medication.
Informed Consent:
By signing this form, you acknowledge the following:
Understanding of Services
You understand the nature of massage therapy, assisted stretching, and bodywork services and the types of techniques that may be used, including but not limited to Swedish massage, deep pressure work, myofascial-style techniques, stretching, compression techniques, and pressure-based modalities. You may ask questions at any time.
Fully Clothed Bodywork
Services are typically performed with the client fully clothed. Clients are encouraged to wear fitted, comfortable activewear that allows for safe movement and stretching. Clients may request reasonable modifications to their care. All services will be provided within the practitioner’s scope of practice, professional judgment, and applicable Ohio practice standards, including proper draping procedures when applicable.
Assisted Stretching and Mobility Techniques
You understand that assisted stretching and mobility sessions may involve practitioner-guided movement of joints and limbs, stabilization of body segments, application of pressure to muscles and fascia, use of straps, bolsters, tables, or other supportive equipment, and use of the practitioner’s body weight, hands, forearms, legs, or feet to provide leverage, stabilization, or controlled pressure during stretching or mobility techniques.
Scope of Practice
Practitioners are not permitted to diagnose medical conditions, perform chiropractic adjustments, or provide physical therapy services. Massage and bodywork techniques are provided within the practitioner’s training and legal scope of practice.
Right to Refuse or Modify Treatment
You have the right to stop the session, request modifications, or decline any technique for any reason without explanation. Your comfort and safety are priorities. You understand that you may withdraw consent and stop services at any time.
Health Information
You agree to provide accurate and complete health information, including injuries, medical conditions, surgeries, medications, pregnancy status, or physical sensitivities that may affect treatment. You understand that withholding relevant health information may pose a risk during services and accept responsibility for such risks.
Risks and Benefits
Bodywork, massage therapy, assisted stretching, and movement-based services involve inherent physical risks. Possible side effects may include muscle soreness, bruising, temporary inflammation, fatigue, emotional release, aggravation of existing conditions, strain, sprain, lightheadedness, dizziness, or tenderness following treatment. In cases of significant physical dysfunction, bruising, popped capillaries, or increased soreness may occur temporarily.
Here at Alfa Therapy LLC, sessions may involve changes in body awareness and nervous system responses as tension patterns decrease and mobility improves. Some clients may experience temporary sensations such as heaviness, floating, fatigue, or feeling disoriented after a session. These responses are typically temporary and resolve with rest and hydration. Clients experiencing significant pain, mobility limitations, or nervous system sensitivity may wish to arrange transportation assistance following a session if they feel it is appropriate for their comfort and safety.
Techniques will be adjusted to your tolerance and comfort level. You agree to immediately communicate discomfort, pain, numbness, dizziness, or unusual sensations during a session.
Results from massage therapy and bodywork vary and cannot be guaranteed.
Draping and Professional Boundaries
Professional boundaries are maintained at all times. When skin contact is involved, proper draping procedures will be used in accordance with professional standards. Sexual comments, misconduct, or inappropriate behavior will result in immediate termination of the session and refusal of future services.
Cancellation Policy
Clients must provide 24-hour notice for cancellations. If less than 24-hour notice is given, clients will have a four-day window to reschedule. Failure to reschedule within that timeframe may result in a cancellation fee.
Confidentiality
All client information is confidential and will not be shared without written permission, except when required by law.
Liability Release
You voluntarily assume responsibility for risks associated with massage therapy, assisted stretching, and movement-based bodywork services provided by Alfa Therapy LLC. You release and hold harmless Alfa Therapy LLC, its practitioners, employees, and independent contractors from liability for injuries or adverse reactions that may occur during or after services, except in cases of gross negligence or willful misconduct.
Consent to Treatment
By signing below, you affirm that you have read and understood this consent form, have disclosed relevant health information, understand the nature of massage therapy and bodywork services and their limitations, and give consent to receive services from Alfa Therapy LLC.
