Cliniqapps

First Name *

Last Name *

Date of Birth *

Privacy

Do you agree to allow health professionals at Live Well to discuss or share information about your health concerns for the purpose of providing more effective treatment?

Yes
No

Consent for treatment, please check the box to confirm you understand that:

This is a massage/bowen treatment and is not a medical or allied health treatment (physiotherapy, osteopathy, chiropractic) *

The physical assessment and treatment typically involves partial undressing and will require the therapist to palpate (touch) the area(s) of my body relevant to my presenting condition. *

My therapist will leave the room whilst I undress/dress and areas of my body not being treated will be draped (covered) with towels throughout the treatment. *

The therapist will explain the treatment options to me as well as outline any associated risk and possible side effects of the treatment options. *

The therapist will discuss the massage/bowen procedures, the areas of the body to be treated, the undressing procedures, the draping procedures and the positioning on the table for and during treatment. *

I have the right to refuse treatment, to make changes to the treatment and to stop the massage at any time. *

I have the right to request the evidence for treatment that may include the abdomen, anterior and lateral chest, and buttock and/or groin areas. I understand I have the right to refuse or modify treatment of these areas. *

Further areas of concern?

Please list any areas that you do not want touched e.g. face, ears, feet stomach etc

Please tell us about any other questions or points of concern you have about your massage/bowen treatment. Your comfort is our top priority so please don't hesitate to let us know.

Cancellation policy

Please note that we need at least 24 business hours notice for all cancellations otherwise a 60% fee will apply. If you fail to attend your appointment without giving us a minimum of 2 business hours notice to cancel, you will be charged 100% of the appointment fee. Please call us on 02 6295 0400 if you need to cancel and leave a voice mail if we don’t answer, or reply to your sms reminder, or email us at info@livewellnaturally.com.au

We require that Monday appointments are cancelled via phone call, voicemail, SMS or email before Saturday close of business at 12pm. If you think you are coming down sick 2 business days beforehand (when your sms reminder comes in), we recommend to cancel then call us back on the day if you feel well. We can then do our best to book you in. If you come down sick on the morning of your appointment and give us more than 2 hrs notice, the 60% fee will apply. We ask that you please stay home if you are unwell.

Please sign within the box.

Massage Consent Form