Your Name *

First Name

Last Name

Contraindications *

See below for some questions or contraindications to massage and let me know if you have any issues that would make massage unsafe for you. Take a look at the below and let me know if you have any issues that would make it unsafe for you to receive massage. Cautions about massage include the following: Vigorous massage should be avoided by people with bleeding disorders, low blood platelet counts and by people taking blood-thinning medications such as Warfarin. Massage should not be done in any area of the body with blood clots, fractures, open or healing wounds, skin infections, weakened bones (such as from osteoporosis or cancer) or where there has been a recent surgery. Although massage appears to be generally safe for cancer patients, they should consult their oncologist before having a massage that involves deep or intense pressure. Any direct pressure over atumor usually is discouraged. Cancer patients should discuss any concerns about massage with their oncologist. Pregnant women should consult their health care provider before using massage. General Contraindications For certain medical conditions massage is generally contraindicated, or should be avoided at the time. These include: systemic contagious or infectious diseases, including the common cold acute conditions requiring first aid or medical attention severe unstable hypertension significant fever. Local Contraindications: For the following conditions massage is locally contraindicated, or the affected areas are to be avoided: - Acute flare-up of inflammatory conditions such as rheumatoid arthritis Deep vein thrombosis aneurism frostbite local contagious or irritable skin conditions open sores or wounds recent surgery recent burn varicosities malignancy Massage does not constitute medical treatment and is not a substitute for a medical examination or diagnosis. If you are dealing with a serious health condition check with your health care provider before seeking massage and make sure you inform your massage practitioner of any health conditions that may affect the work.

I understand the above statements and agree to make known any contraindications

I do NOT agree to disclose information about contraindications

Informed Consent *

I understand that the massage given to me by Eric Bryant is for the purpose of (stress reduction, pain reduction, relief from muscle tension, increasing circulation, or specific reasons stated below). I understand that the practitioner does not diagnose illness or disease and does not prescribe medical treatment or pharmaceuticals, nor are spinal manipulations part of massage. I understand that massage is not a substitute for medical care and that it is recommended that I work with my primary caregiver for any condition I may have. I have stated all my known physical conditions and medications, and I will keep the practitioner updated on any changes.

I have read, understand, and agree with the above statement.