Pregnancy Massage Therapy Form

• Massage therapy is intended a complementary therapy and does not replace the need for medical diagnosis, where appropriate.
• The techniques will be explained prior to and/or during treatments. I can ask questions regarding techniques being used and I can ask for treatment using a particular technique to cease at anytime for any reason.
• The therapist has explained the associated risk and possible side effects with the treatment options as described.
• The therapist has discussed the massage procedures, the areas of the body to be treated, the undressing and dressing procedures, the draping procedures and the positioning for and during the treatment.
• I have given the massage therapist my relevant medical history to the best of my knowledge and if any changes occur in my medical history, I will inform the massage therapist prior to the massage appointment.
• I understand that the physical assessment and treatment may involve partial undressing and may require the therapist to palpate (touch) the area(s) relevant to my presenting condition.
• I release the massage therapist (Sarah Hughes) and Cancer Care Association from all liability for any harm that may unintentionally result from this treatment.

Privacy & Confidentiality

I authorise the massage therapist to release or obtain information regarding my massage treatment and medical history to/from my prenatal care provider, other doctors, and the Childhood Cancer Association Family Service Team. Confidentiality is respected and at no time is any information received during the massage session given to another person, except to above personnel.

I understand that as part of providing the massage therapy service, we will need to collect and record personal information that is relevant to service provision. This information is a necessary part of the services provided and guides treatment. The information is stored securely. It is only accessed by the massage therapist and as required, by authorised staff and personnel engaged by the Childhood Cancer Association. The information is stored in a physical filing cabinet at the Childhood Cancer Association office, and all archived files are held in a secure cloud-based storage system. All files are kept for a minimum of 7 years.