Informed Consent - Massage Therapy: Benefits and Risks
This file outlines the benefits and risks of massage therapy, confidentiality and release of information, and informed consent. It is essential for participants to understand and acknowledge these details before participating in the massage therapy program. The form includes sections for client, guardian, and massage therapist signatures.
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How do I fill this out?
Filling out this form involves reading and acknowledging the benefits, risks, and confidentiality terms of massage therapy. You will need to provide personal information and disclose any pre-existing conditions. Signatures from the client, parent/guardian (if applicable), and the massage therapist are required.
How to fill out the Informed Consent - Massage Therapy: Benefits and Risks?
1
Read the benefits, risks, and confidentiality terms of massage therapy.
2
Provide personal information and disclose any pre-existing conditions.
3
Acknowledge understanding and acceptance of the terms.
4
Sign the form as the client and obtain a parent/guardian signature if under 18.
5
Have the massage therapist sign the form.
Who needs the Informed Consent - Massage Therapy: Benefits and Risks?
1
Massage therapy participants who need to acknowledge and consent to the risks and benefits.
2
Parents or legal guardians of participants under 18 who need to provide consent.
3
Massage therapists who need to obtain informed consent from clients.
4
Health care providers who require a signed consent form for clients with known heart problems.
5
Insurance administrators/carriers who need consent information to determine eligibility for coverage.
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With PrintFriendly, you can easily edit this PDF to include your personal information and any required consent. Use our intuitive editing tools to fill out the necessary fields accurately. Save and download the edited PDF for your records.
1
Upload the PDF file to PrintFriendly.
2
Use the editing tools to fill out your personal information and disclose any pre-existing conditions.
3
Ensure all necessary fields are completed, including client and parent/guardian signatures.
4
Have the massage therapist sign the form.
5
Save and download the completed and signed form.
What are the instructions for submitting this form?
Submit the completed form to the University of Northern Colorado Campus Recreation. You can email it to campusrec@unco.edu, fax it to (970) 351-1055, or deliver it in person to the Campus Recreation Center at 501 20th St, Greeley, CO 80639. Ensure all fields are accurately filled out, and required signatures are obtained. Keep a copy of the completed form for your records. Our advice is to carefully review all information before submission and follow up with the appropriate department if you have any questions.
What are the important dates for this form in 2024 and 2025?
Important dates vary by individual appointment and participation schedule. Ensure you provide a 24-hour notice for cancellations.
What is the purpose of this form?
The purpose of this form is to inform participants about the benefits and risks associated with massage therapy. It ensures that participants acknowledge and consent to these terms before engaging in therapy. It also gathers necessary personal information and signatures to validate informed consent and facilitate communication with healthcare providers and insurance administrators.
Tell me about this form and its components and fields line-by-line.
- 1. Benefits: Outlines the general benefits of massage therapy, including stress reduction and relief from muscular tension.
- 2. Risks: Details the immediate physical risks associated with massage therapy, such as bodily discomfort and muscular tenderness.
- 3. Confidentiality and Release of Information: Explains the confidentiality of personal information and the conditions under which it may be released.
- 4. Informed Consent Statements: Includes statements that participants must read and acknowledge, emphasizing the limitations and conditions of massage therapy.
- 5. Cancellation Policy: Specifies the requirement of a 24-hour notice for cancellations to avoid charges.
- 6. Physical Injury Clause: Describes the procedure and financial responsibility in case of physical injury during therapy.
- 7. Signatures: Sections for the client, parent/legal guardian (if under 18), and massage therapist to sign and date the form.
What happens if I fail to submit this form?
Failure to submit this form may result in the inability to participate in the massage therapy program. It is crucial to complete and submit the form to ensure informed consent and proper documentation.
- Ineligibility for Massage Therapy: Without a signed consent form, you will not be allowed to participate in the massage therapy program.
- Lack of Documentation: Failure to submit the form means crucial personal information and acknowledgment of risks and benefits will not be documented.
- Insurance Issues: Ineligibility for insurance benefits coverage may arise if the consent form is not submitted.
How do I know when to use this form?
- 1. Before Participating in Massage Therapy: Complete and submit the form prior to your first massage therapy session.
- 2. If You Have Known Heart Problems: Ensure you have a signed consent form from your healthcare provider on file.
- 3. For Insurance Purposes: Provide the form to the insurance administrator/carrier to determine eligibility for coverage.
- 4. If You Are Under 18: Obtain a parent or legal guardian's signature for consent.
- 5. In Case of Cancellation: Follow the 24-hour notice requirement to avoid charges.
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Use our signature tool to add your digital signature, as well as any required signatures from parents/guardians or massage therapists.
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Yes, you can save and download the edited PDF for your records once you have completed all necessary fields.
What information do I need to provide on the form?
You need to provide personal information, disclose any pre-existing conditions, and obtain signatures from the client, parent/guardian (if under 18), and the massage therapist.
Do I need a healthcare provider's consent?
If you have known heart problems, you must have a signed consent form from your healthcare provider on file.
What should I do if I need to cancel a session?
If cancellation is necessary, a 24-hour notice is required. If proper notice is not given, the session will be charged and forfeited.
What happens in case of physical injury during the massage?
In the unlikely event of physical injury, immediate medical treatment will be obtained at the nearest healthcare facility, and the costs will be the participant's financial responsibility.
Can I use the form for insurance purposes?
Yes, the form may be released to the insurance administrator/carrier to determine eligibility for medical benefits coverage.
How do I know if I need to use this form?
You need to use this form if you are participating in massage therapy and need to acknowledge and consent to the benefits, risks, and confidentiality terms.
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