Informed Consent
1: Payment and
Confidentiality
It is my commitment
to be on time for our sessions and maintain your privacy and confidentiality. I
will maintain a professional, clean space that is safe physically and
psychologically. I will be present in our sessions and give you my full
attention and best work. In return, I expect you to also make every effort to
arrive on time, clean, and ready for our sessions. Payment is due at the time
of the session in cash or check. The fee for returned checks is $20. If you
need to cancel a session, I ask that you give 24 hour notice or I will expect
payment for the session.
It is my professional
duty to maintain your privacy and confidentiality. Some conditions may require
my communication with your doctor or other professionals, but I will ALWAYS
seek your written consent before disclosing any information about our work to
other parties.
2: Purpose of Massage
Massage and bodywork
can help relax a person and relieve stress. It can help rehabilitate after an
injury or surgery, or help with pain, arthritis, and many other conditions.
Therapeutic massage can improve quality of life and the function of the body,
and prevent injury or pain in the future, However, none of these results are
guaranteed. If you feel that you are not getting as much benefit from our work
as you would like, please let me know and we can try another approach. Every
therapist and every client are different- you may respond differently than
others.
Please understand
that my work is therapeutic, designed to enhance your life and help you achieve
wellness- it can be very enjoyable, but it is NOT sexual.
3: Other information
Most people disrobe
fully for therapeutic massage sessions, but please only remove what you are
comfortable with. You will be draped at all times, except in the immediate area
I am working on. If you feel pain, or discomfort, please let me know, as my
goal is for you to benefit from my work.
If you have any
questions about therapeutic massage or any aspect of my work, please ask! You
will see greater benefit from our work the more you are involved!
I, _______________________________ have read and understood this information
and agree to receive therapeutic massage from Jen Kobrick, LMT
X__________________________________________________ Date: _____________
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