01

Assessment

COVERING YOUR HEALTH HISTORY:
COVERING YOUR HEALTH HISTORY:

What your goals in the therapy session will be, what your needs are. Next will be discussing the nature of the pain or issue: Location of pain, onset (when it happened), radiate to or where, duration of pain, frequency of issue,
intensity of pain, characteristic of pain, Aggravating factors, relieves the pain or issue, how long you
have had the pain, any other factors and medications being taken.
I.e. medications and personal injuries. Or surgeries or pins, replacements.

Treatment plan and assessment of patient/client

The therapist will take you through:
 
Your range of motions of your arms, legs, back, neck moving your limbs around. (Playing Simon says close example.) figuring out where your pain and limitations may be.

Through special orthopedic tests. Know to find exact and reasonable differentiation of numerous body
parts. Be it ligaments, muscular, or structural or postural inconsistences.

Giving you a clear and reasonable reason for the Pain is coming from and possibility why
this includes strength and /muscle grading /postural assessment / balance, gait and walking assessment
giving me a understanding of where we are to start and how I can resolve some if not all of your physical
restraint. The goal is to improve your quality of life.

A course and plan of action. Can be changed, improved, or manipulated at any time by (client or
therapist). It may also show results of where you are going and keeping up with current progress or
showing improvement. And what direction of treatment may be needed. This plan will change as your
health and muscles improve.

PLEASE NOTE:
MASSAGE IS NOT A SEXUAL EXPERIENCE
NO SEXUAL ACT WILL EVER BE PERFORMED ON THE TABLE
NO GENITALS, NIPPLES OR GLUTEAL CLEFT WILL EVER BE TOUCHED

02

Your Goals

SPECIAL CONSENT FORM
SPECIAL CONSENT FORM

Filling out and explanation.

What is acceptable by you in areas of sensitivity. Including ticklish and physically stimulating regions(you
can ask the therapist to change tempo/pace or pressure or technic to diminish these types of instances.
Which is recommended

GLUTES/BUM can be draped up to the underside or crease to ischial tuberosity. Or can expose the
whole gluteal muscle to the top of the hip.

Working over the sheets is also another way to apply massage to suit your comfort level.
INSIDE OF LEGS OR GROIN AREA (adductors), from the knee leading up to the groin area.
SIDE OF CHEST WALL (may needed to be applied when working on rib cage/ lung regions/abdominal/
into the arm pit region.

During the massage the therapist will never go past the draping’s for any reason what so ever. This is
against the code of honor and standards of practice.

Breast Massage:
The patient will be face up… a towel will be draped over the breast area. Sheet will be tucked in around
the waist area. Only one breast will be exposed at a time.

A breast massage is medically recommended if an augmentation has been preformed.

Other reasons for a breast massage could or may not be limited to lumps, grainy feeling, pain in general
area, or discomfort leading into the arm pit. Breasts are supposed to naturally loose and smooth feeling
any other inconsistencies may represent block lymphatic ducts in the surrounding tissue. In which cases
a recommendation may be requested.

NO TOUCHING OF THE NIPPLE OR ARIOLA
Special consents (you will have to sign off every time the therapist works in these areas (per
appointment)

03

Massage

CONSENT TO MASSAGE
CONSENT TO MASSAGE
Steps that will be taken:

Discuss how to get on and off the table (assistance for elderly or disabled people)
When to get changed and how to disrobe to your comfort level. The therapist will give time for you to
change (will not be in the treatment area). All massage is tailored to your needs and requests
Work can be preformed with clothes on Corporate massage which May inhibit or limit the therapist’s
ability to work into all areas or preform the best possible massage.

European standard with all clothes removed including under garments.

Which is STANDARD in massage. It is the best practice. That way no clothes may be soiled with massage
oils and it will also give the therapist full ability to preform work needed

Note:
Massage therapy will only be performed on the area uncovered to be worked on.
I.e. back, shoulders, one leg at a time. Arms and forearm. Stomach/abdominal area
Proper breathing technics will be discussed. Deep diaphragmatic breathing encourages and promotes
relaxation, blood flow, decreases mental stress and help with discomfort and pain management
Speaking about Pain and your tolerance. Some technics may be a little discomforting and cause a slight
stinging to intense sensation.

The therapist will work within your pain thresh hold and tolerances. 0 being no pain and 10 being the
worst pain you have ever felt in your life.

Please let the therapist know when you are reaching your threshold. A good recommendation is never
passing the 7/8 point (prevents possibility of bruising or long-standing discomfort)
A good therapist will always be checking in with you for discomfort and pressure.
There are many different technics a therapist can and may use. IF at anytime you dislike or want the
therapist to change or stop. DON’T HESITATE TO ASK.

I will never be offended by any question, personal choice, or preference.

There is a chance that their may be some minor bruising.

The next day you may feel like you have been put through a good workout (slightly sore) for the next
few days after a massage. Generally, there is some discomfort following a massage. It is only temporary
REMEMBER. The therapist is restructuring muscle tissue and fibers which causes this sensation. IF you
feel any pain longer than 3 days don’t hesitate to call the therapist for recommendations