Required at booking

Massage Therapy Consent Form

This form is required for all clients at the time of scheduling or payment. Please read each section carefully and provide your electronic signature at the bottom.

Your information is kept strictly confidential. This consent form is required for all massage therapy clients and is kept on file at Life Aligned Care Bridge.

Client Information

First Name*

Last Name*

Date of Birth*

Phone Number*

Email Address*

Informed Consent to Treatment

Please read each statement carefully and indicate your agreement. All items marked with * are required.

Consent to Massage Therapy*

I voluntarily consent to receive massage therapy services from Life Aligned Care Bridge. I understand that massage therapy is not a substitute for medical treatment and that my therapist does not diagnose medical conditions or prescribe treatment.

Scope of Practice*

I understand that massage therapists at Life Aligned Care Bridge are licensed professionals who practice within the scope of massage therapy. They do not perform medical diagnosis, chiropractic adjustments, or any service outside the scope of licensed massage therapy.

Right to Refuse or Stop Treatment*

I understand that I have the right to refuse or stop any massage technique at any time during my session without penalty. I agree to communicate openly with my therapist about my comfort level, pressure preferences, and any discomfort.

Cancellation Policy*

I understand that Life Aligned Care Bridge requires at least 24 hours' notice for cancellations or rescheduling. Late cancellations or no-shows may be subject to a cancellation fee. I agree to notify the practice as soon as possible if I need to cancel or reschedule.

Privacy & Confidentiality*

I understand that my health information, intake forms, and session notes are kept strictly confidential and will not be shared with third parties without my written consent, except as required by law.

Health Disclosures

Do you have any conditions, injuries, or contraindications that may affect your massage session?*

Are you currently pregnant?*

Are you currently under a physician's care for any condition?

Electronic Signature

By typing your full legal name below, you confirm that you have read and understood this consent form, that all information provided is accurate to the best of your knowledge, and that you agree to all terms stated above. Your typed name serves as your legally binding electronic signature.

Electronic Signature (type your full legal name)*

Typing your name constitutes your electronic signature and has the same legal effect as a handwritten signature.

If signing on behalf of a minor, your relationship to the client

Fields marked * are required. Your information is kept strictly confidential.