Massage - Oncologist Consent

Oncology massage is a gentle, safe, and effective massage technique that is comforting and nurturing for anyone with cancer, a history of cancer, or in a fragile state of health.

I acknowledge that the massage therapy is contraindicated if the patient has any of the following:

Blood clot/s or blood condition
DVT (Deep Vein Thrombosis)
High blood pressure
Fever
Acute infection
Open wounds, sores or lesions
Skin conditions or disorders which may be contagious or cause inflammation
Received immunisation/vaccination in the past 48–72 hrs
Diarrhoea or other undiagnosed illness/sickness
Heat, redness or swelling of the skin
Severe neutropenia

This is to certify that I am aware that (patient name) wishes to receive an oncology massage, conducted by qualified oncology massage therapist, Sarah Hughes, and that there is no significant medical reason that would prevent this treatment from proceeding.

Comments & considerations

(this may include lymph node removal, surgery (within the past six weeks), chemotherapy drugs (ie Cyclopphamine (Cytoxan)/5FU (Fluorouracil)/steroid cream), radiotherapy, medical devices, inguinal catheter):

Oncologist's name

First name

Last name

Oncologist's signature

Date