Oncology Massage Medical Consent Form

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.