Massage on Oxford Client Intake Form

Medical History Please tick all conditions that apply (including past conditions)

Listed below are potential risk associated with massage and other treatments we provide. Please read carefully, if you do not understand please ask for a further explanation.

Therapy Possible Risk Strategies to Minimise Risk
Aromatherapy Aromatic interaction or response Some essential oils mixed with alcohol, medications and may irritate or photo-sensitise skin, cause blood thinning or euphoria and may negate homeopathic remedies. Not recommended for infants, pregnancy, breast feeding or heart & kidney problems or allergies.
Any Therapy Aggravation of your current Condition It is possible that your condition could be aggravated by treatment. With a full medical history, therapists will be able to adjust the treatment to minimise the risk of aggravating existing conditions.
Massage Cupping Bruising Please inform the therapist if you bruise easily, have bleeding disorders or are taking blood thinners. Cupping will typically leave marks, they are painless and can last over a week.
Massage Acupunture Cupping Aromatherapy Fainting Please advise your therapist if you have low blood pressure, do not skip a meal before treatment. Keep well hydrated.
Massage Acupunture Cupping Infection It is possible to develop infection of the hair follicles(folliculitis) from friction or whenever the skin is punctured. Advise your therapist if you have a known skin condition(s) and/or immune problems. Some medications can affect your skin and immune system. Acupuncture needles are pre-sterilized, single use disposable needles.
Massage Acupunture Cupping Pain Pain response can be stimulating by on the skin by pricking, burning, crushing, or freezing. Please advise your therapist if you are sensitive to specific stimuli and if you become uncomfortable or experience any pain. Any treatment should not cause unbearable pain.
Any Therapy Pregnancy complications Please inform us if you are currently pregnant (including how long) and declare all medical conditions and any issues regarding your pregnancy. Please immediately inform us if you feel any discomfort during your treatment.
Massage Acupunture Cupping Relaxed/Sleepy It is common to feel sleepy after treatment, avoid getting up too quickly, take time to adjust after the treatment before driving and walking down stairs. Avoid driving tired. Keep well hydrated after treatment.

Please read and understand the following terms

If I experience any pain or discomfort during my session, I will immediately inform the therapist so that the pressure and/or strokes may be adjusted to my level of comfort. I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapist's part should I fail to do so. I can ask questions in regards to my treatment, and have it adjusted as needed as well as stop the massage however I will be liable for part of the costs of the treatment. I understand that massage cannot be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician other qualified medical specialist for any mental or physical ailment that I am aware of. I have read and understood all the information outlined in this form including the possible risks associated with my circumstances may have a bearing on my decision to process with the treatment.

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