Informed consent is a process by which a fully informed client consents to participate in the massage treatment. It originates from the ethical (and legal) right of the client to direct what happens to his body, and from the ethical duty of the therapist to involve the client in choices related to his wellness. In order for the client’s consent to be valid, he must be considered competent to make the decision to consent, and that consent must be voluntary. Parents or legal guardians must provide informed consent for minors, or for those unable to consent on their own due to mental or physical challenges.
Standards and Ethics
With respect to standard of practice and informed consent, the therapist is obligated to fully inform the client of choices relating to her care, and disclose policies and limitations that may affect her care. The therapist will not provide massage without obtaining informed consent.
In our Code of Ethics, ABMP stipulates that practitioners must “recognize a client’s right to determine what happens to his or her body. I understand that a client may suffer emotional and physical harm if a therapist fails to listen to the client and imposes his or her own beliefs on a situation. I will fully inform my clients of choices relating to their care, and disclose policies and limitations that may affect their care. I will not provide massage without obtaining a client’s informed consent (or that of the guardian or advocate for the client) to the session plan.”
Obtaining Consent
The process of obtaining the client’s informed consent takes place during the first health intake procedure before the client receives a massage. During this exchange, the massage therapist provides specific types of information and the client signs a form stating that he understands, and would like to participate in the massage treatment.
Sometimes the client is handed numerous documents such as a menu of services with fees and business policies, a brochure on what to expect during a massage, and a short informed consent form. You could also choose to include all or some of the information in one document, as in the sample that begins on page 41. Use this language in your own document by substituting your information for the sample information. When the client has read and understood the informed consent information, the client signs it and a copy is placed in the file.
Information provided to the client includes:
• A written and verbal description of massage, its limits, its benefits, indications, contraindications, and risks, along with some suggestions of alternate therapies that have benefits similar to massage.
• A written and verbal description of the massage scope of practice in the relevant state, or directions to the website where the client can read the massage scope of practice, and the contact details for reporting therapist misconduct.
• A written and verbal description of the therapist’s training, credentials and experience, and disclosure of any factors that limit the therapist’s professional ability such as hearing disorders, vision impairment, or lack of experience in a particular relevant area (e.g., the client is pregnant and the therapist has never before given a prenatal massage).
• A written and verbal description of business policies relating to the professional relationship between the client and therapist. This would include the fee schedule, hours of operation, returned check policy, late arrival or no-show policy, policy on draping, sanitation protocols, and expectations on the client’s conduct. For example, “The client is expected to demonstrate good hygiene and not use illegal drugs or alcohol before a session.”
• A written and verbal description of activities or behaviors that constitute sexual impropriety and the consequences of such behaviors (i.e. termination of the session, report to the police).
• A written and verbal description of the rights of the client including the right to terminate the session at any time, confidentiality, and the limits of confidentiality.
Informed consent procedures benefit both the client and the therapist because they clarify the expectations of both parties and provide guidelines for how sessions are conducted. Informed consent establishes the framework of the therapeutic relationship. This empowers the client to feel in charge of his session and supports therapists in setting good boundaries with clients.
Anne Williams is the director of education for Associated Bodywork & Massage Professionals and author of Massage Mastery: from Student to Professional (Lippincott Williams & Wilkins, 2012), from which this article was adapted, and Spa Bodywork: A Guide for Massage Therapists (Lippincott Williams & Wilkins, 2006). She can be reached at anne@abmp.com.
Informed Consent Sample Form
The following details the kind of information you may want to include in your practice’s Informed Consent Form.
Welcome to Any Massage Clinic
Massage Defined
Massage can be defined as structured, professional touch. Massage techniques manually manipulate the muscles, tendons, and fascia of the body to promote health and wellness. Benefits of massage include stress reduction, circulation enhancement, increased relaxation, and relief from muscular tension, soreness, and pain. People may find that meditation, as well as other bodywork systems like myofascial release and energetic bodywork, provides results similar to relaxation massage.
Limitations of Massage
Massage therapists do not diagnose medical diseases or musculoskeletal conditions and massage is not a substitute for medical examination and treatment. Massage therapists do not prescribe herbs or drugs, including aspirin or ibuprofen, or medical treatments. They do not perform spinal adjustments and they cannot counsel clients about emotional or spiritual issues as would be provided by a mental health professional or spiritual leader. If you experience symptoms that lead you to believe you may have a medical condition, it is recommended that you visit a physician for diagnosis and treatment. For a detailed description of the massage scope of practice in this state, please visit the Board of Massage website at www.anyboard.com.
Adverse Reactions to Massage
Massage may lead to adverse reactions in certain situations or when used with certain conditions or medications. The massage therapist will evaluate your health-history intake and ask you questions to make sure it is safe for you to receive massage. In the event the massage therapist is uncertain that massage will be of benefit to you, he or she may ask you to provide a note from your physician stating that it is safe for you to receive massage. Please provide complete details of medical conditions and medications to your massage therapist during the health-intake interview. Failure to inform the massage therapist of all medical conditions and medications may place you at increased risk for adverse reactions.
Any Massage Clinic and You
Therapist Training and Experience
All of the massage therapists working at Any Massage Clinic have completed a minimum of 500 hours of massage training from a state-approved school and passed the state licensing requirements. Therapists at Any Massage Clinic are knowledgeable in Swedish massage, and deep-tissue and myofascial release techniques, as well as hydrotherapy. We also have therapists who specialize in prenatal massage, reflexology, spa body treatments, and craniosacral therapy. Pick up a menu of services from our receptionist to learn more about these forms of bodywork. Please ask us for a copy of our preferred provider list in the event we can’t meet your particular needs.
Business Policies and Practices
You may book a 30-minute ($40), 60-minute ($80), or 90-minute ($120) session. Any Massage Clinic accepts cash, personal checks, and all major credit cards. We do not bill insurance companies for services. Plan to arrive 10 minutes early to update your paperwork and discuss any changes to your condition with your massage therapist. The first session usually requires a longer health intake process, so new clients should arrive 20 minutes early on their initial visit. Clients arriving late will be charged for the full session and the session will end promptly at the scheduled time. Clients must cancel sessions with 24 hours notice or pay for the missed session in full. Returned checks will be charged a $20 processing fee. Business hours are from 8:00 a.m. to 8:00 p.m. Walk-in appointments are accepted if therapists are available. Children and teens are welcome, but an adult guardian must be present with the minor in the treatment room for the entire session.
Clients receive $10 off their first massage at Any Massage Clinic. Clients receive $10 toward a massage for each friend or family member they refer to the clinic. Occasionally coupons for discounts on services are sent as part of our client newsletter. Sign up for our free newsletter with the receptionist. A tip to the therapist for exceptional service is optional, but appreciated.
Expectations and Rights
The client is expected to demonstrate good hygiene and not use illegal drugs or alcohol before the session (the use of drugs and alcohol make it unsafe for a client to receive massage). Clients and therapists are expected to refrain from any behavior of a sexual nature, including sexual jokes, nicknames, or immodest conduct. Sexual behavior from the therapist toward a client is grounds for therapist termination and may lead to a formal complaint filed with the state board of massage. This may lead to the loss of the therapist’s license. Sexual behavior from the client toward the therapist is inappropriate and will lead to the termination of the session and refusal of further service.
The client has a right to prompt, professional service in an environment that is clean, private, and safe. Client information is not shared with any members of the public or other health-care providers unless the client releases the information in writing. A court of law may order the client’s health-care records released to the court as part of a legal proceeding. Therapists are obligated to report information about the abuse of a child, elderly person, or mentally or physically challenged person in the event that such information is related during the session. Therapists are obligated to report threats of self-harm, or threats that the client plans to harm another person, to authorities.
The client has the right to end the session at any time should they feel dissatisfied or uncomfortable with the session in any way. Clients who are dissatisfied with a therapist are encouraged to contact the clinic manager. Formal complaints can be filed with the state on the Board of Massage website.
Your Massage Session
After you complete the health intake form, the therapist will take you to a private treatment room, review the form with you, and discuss your goals for the session. The therapist will customize the massage to meet your specific needs within the limits of his or her training and scope of practice. The therapist will then leave the room while you undress and position yourself under the drape on the massage table. Only the area being massaged at the time is undraped as the session proceeds. The breasts, genitals, and anus are never undraped during a session, and every effort is made to respect and protect both the client’s and therapist’s modesty. You may leave on your underclothing if you prefer. While the therapist will ask you a few questions—for instance, about the comfort of the stroke pressure, room temperature, or choice of session music—and you should let the therapist know immediately if you are not comfortable, other conversation during the session is generally discouraged. Silence allows you to relax fully and enjoy the session.
Informed Consent
I, (client’s name) have read and understand the disclosures, policies, and procedures of Any Massage Clinic, and I would like to receive a massage session or request a session for my child or dependent. I understand the benefits and limits of massage therapy and understand massage may cause adverse reactions in certain situations. If I experience any discomfort during the session, I will immediately inform my therapist so he or she can modify the massage strokes. I understand massage therapists do not diagnose diseases or conditions, prescribe medications or treatments, or perform spinal adjustments. I recognize massage is not a substitute for medical treatment and should I need medical treatment, I will seek out the appropriate health-care professional (physician, psychotherapist, chiropractor, etc.). I understand that it is my responsibility to keep the massage therapist informed of changes in my (or my child’s or dependent’s) health status, diagnosed medical conditions, and medication. I understand that failure to inform the therapist of these changes may place me (or my child or dependent) at greater risk of adverse reactions to massage. I release the massage therapist of any liability if I fail to disclose the appropriate health-related information.
Client’s Signature:
Date:
Therapist’s Signature:
Date:
I authorize the therapists of Any Massage Clinic to provide massage to my child or dependent:
Name of Child or Dependent:
Parent or Guardian Signature:
Date:
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