INFORMED CONSENT: By checking this box I give full consent to undertaking any treatment, and in doing so I understand that the therapist in providing services within their scope of practice as defined by the Sports Therapy Association. I acknowledge that the therapist is not a physician and does not diagnose illness or disease or any other physical disorder. I clearly understand that massage therapy or any associated treatments is not a substitute for a medical examination.

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UNDERSTANDING RISK: By Checking this box I acknowledge that no assurance or guarantee has been provided to me as to the results of the treatment. I acknowledge that

with any treatment there can be risks and I understand and assume those risks. *

MEDICAL INFORMATION: By Checking this box I acknowledge and

understand that the therapist must be fully aware of my existing medical conditions. I have completed my medical history form

as provided and disclosed to the therapist all of those medical conditions affecting me. The information I have provided is true

and complete to the best of my knowledge.*

SIGNED CONSENT: BY Checking this box I  confirm my consent to treatment and intend this consent to cover the treatment discussed with me and such additional treatment as proposed by my therapist from time to time, to deal with my physical condition and for which I have

sought treatment. I understand that at any time I may withdraw my consent and treatment will be stopped.*