Informed Consent Esign

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.

Limitations of Massage

Massage therapists do not diagnose medical diseases or musculoskeletal conditions and massage is not a substitute for medical examination or 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 issues as would be provided by a mental health professional. 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.

Manual Lymphatic Drainage

Manual Lymphatic Drainage, or MLD, is a gentle yet powerful form of bodywork that is intended to stimulate and encourage the natural movement of the lymph, which carries waste products away from the tissues back towards the heart. It is a technique based on gentle, rhythmic and constant movements that mimic the rhythm of the body’s lymphatic system. MLD can only be performed by a licensed massage therapist, physical therapist, or occupational therapist.

Manual Lymphatic Drainage is extremely effective in treating post-surgical swelling caused by liposuction, abdominoplasty, facelift, breast lift/reduction, and any other elective, non-elective, reconstructive, orthopedic and cosmetic surgeries. This treatment is also very effective in reducing the symptoms associated with chronic health conditions, such as autoimmune conditions and Lyme, by reducing the body’s inflammatory response.

Although MLD is beneficial to a number of conditions, it is not for everybody. It is very important that you list all health conditions you have, medications that you take, and all past surgical procedures. Please note that we may need to contact your health care provider for further information on your condition or need a doctor’s approval in writing prior to treatment.

Contraindications for receiving MLD include, but are not limited to congestive heart failure, DVT, kidney disorders, acute inflammation or infection/malignancies, arteriosclerosis, acute cold/flu, and fever.

Adverse Reactions to Massage

Massage and MLD may lead to adverse reactions in certain situations or when used with certain conditions or medications. The practitioner will evaluate your health-history intake and ask you questions to make sure it is safe for you to receive treatment. In the event the practitioner is uncertain that massage will benefit you, he or she may ask you to provide a note from your physician stating that it is safe for you to receive a treatment. Please provide complete details of medical conditions and medications to your practitioner during the health-intake interview. Failure to inform your practitioner of all medical conditions and medications may place you at increased risk for adverse reaction. Please be sure to fully complete all applicable intake forms online before you arrive for your session.

Therapist Training and Experience

All of the practitioners working at the Madison Lymphatics and Bodywork have completed and obtained certification at a state-approved school and have passed the State of Wisconsin’s licensing requirements.

Cancellation Policy

Patients arriving late will be charged for the full session and the session will end promptly at the scheduled time. Patients must cancel sessions within 24 hours notice or pay 100% of their scheduled appointment cost. Children and teens are welcome, but an adult guardian must be present with the minor in the treatment room for the entire session. Madison Lymphatics and Bodywork accepts cash and all major credit cards. We do not bill insurance companies for services.

Expectations and Rights

The patient 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). Patients and practitioners 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 or Physical Therapy. This may lead to the loss of the practitioner’s license. Sexual behavior from the patient toward the practitioner is inappropriate and will lead to the termination of the session and refusal of further service. The patient has a right to prompt, professional service in an environment that is clean, private, and safe. Patient information is not shared with any members of the public or other health-care providers unless the patient releases the information in writing. A court of law may order the patient’s health-care records be released to the court as part of a legal proceeding. Practitioners 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. Practitioners are obligated to report threats of self-harm, or threats that the client plans to harm another person, to authorities. The patient has the right to end the session at any time should they feel dissatisfied or uncomfortable with the session in any way. Patient who are dissatisfied with a therapist are encouraged to contact the clinic owner. Formal complaints can be filed with the state on the Wisconsin Board of Massage website.

Please be sure to fully complete all applicable intake forms online before you arrive for your session or arrive 10 minutes early to do so.

Client’s Declaration of Informed Consent

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