Pre-Treatment Questionnaire

UNDER 16’S MUST BE CHAPERONED

Informed Consent

Benefits of this assessment/treatment

I understand that the treatment I receive is to improve the functionality of soft tissue including impaired muscle, tendons, ligaments and cartilage. Sarah is a qualified sports massage therapist who treats dysfunctional tissue which can reduce the risk of injury.

Scope of Practice

Sarah is not a sports physiotherapist and cannot treat injuries not a psychotherapist and cannot treat mental health. I understand that if I believe I may have an injury, I should see a qualified medical specialist; and if Sarah believes I may have an injury then she is entitled to refuse to treat me and may refer me to an appropriate practitioner. In the interest of prescribing the best treatment plan for you, Sarah may speak to other professionals and third parties for advice or referral.

My Personal Health & Medical Conditions

I have started my current health and medical conditions within this document and I will inform Sarah of any future changes. I will let Sarah know if I feel pain during any assessment/treatment and the level of intensity may be reduced for my own comfort.

Treatment Etiquette & Cancellations I understand that Sarah must keep to her schedule and if I am late for my appointment then the length of time for the booking may have to be cut short. I understand that any cancellations less than 48 hours in advance must be paid for fully. I understand that inappropriate actions or words towards Sarah may result in termination of the assessment and/or any future appointments.

Assessment, Treatment & Referral Expectations

For an effective assessment or treatment, you are advised to wear comfortable clothing such as shorts or vest tops. You may be asked to remove clothing so that Sarah can examine or treat the affected area. The removal of clothing is under voluntary consent and not pressured by Sarah or any other person.

Amongst other techniques, simple kneading friction techniques may be used which may cause bruising, lasting several days post-treatment.

In cases of referral from or working with other professionals, with your consent, Sarah may make clear notes of the assessment or treatment in order to pass the on to the referee or professional. Where realistic, any notes will be passed onto the professional via you, the client. Where this is unrealistic, Sarah may communicate assessment/treatment notes directly to the professional and you have access to these notes if you wish to see them.

Post-treatment, you may feel dehydrated, nausea, muscle soreness experience headaches or flu-like symptoms. This is due to the deep-tissues being worked to break adhesions, allowing increased blood flow and the metabolic waste being absorbed by the lymphatic system. The lymphatic system works to dispose of toxins and the skeletal muscles begin to restore. Staying hydrated before and after treatments can help reduce these short-term side effects.

Having read the above information, I consent to this assessment/treatment taking place. I consent to my data being shared with appropriate third parties/medical practitioners in the interest of prescribing the most appropriate treatment for me.

I would prefer to be contacted via (please tick)
Tick to confirm the terms above. *

Cautions & Contraindications to Treatment

Please Read
Do you have any history with any of these conditions?

Health and Safety

I have been made aware of fire escape routes, first aid location and emergency telephone location.

Health and Safety *

Please read and accept the terms of service. Terms of Service

Terms of Service
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