It is my choice that my child receives massage therapy, a treatment being given for the well-being of body and mind. I agree to communicate with the practitioner if I ever feel my child’s well-being is being compromised. I understand that massage practitioners do not diagnose illness, disease or any physical or mental disorder; nor do they prescribe medical treatment, pharmaceuticals or perform spinal thrust manipulations. I acknowledge that massage is not a substitute for medical examination or diagnosis, and that it is recommended that I see a primary health care provider for that service. I have stated all of my child’s medical conditions that I am aware of and will update the massage practitioner on any changes in health status. I understand that massage sessions are strictly therapeutic; inappropriate behavior will result in termination of the session. I have read the Therapeutic Massage Center of Middleton’s intake questions and understand them.