Covid-19 Medical Declaration - Remedial Massage

Covid-19 Declaration Form

Date of appointment *

Name *

Email Address *

Main contact number *

Emergency contact number

Contraindications of Massage

By ticking this box I declare that to the best of my knowledge I am fit to receive a massage based on the contraindications detailed below.

See CONTRAINDICATIONS OF MASSAGE

Fitness declaration *I declare that I am fit to receive a massage

Covid-19 Statement

By ticking this box I declare that to the best of my knowledge I have not been in contact with anyone infected with Covid-19 in the last 2 weeks and that I show no signs or symptoms.

Covid-19 declaration sign *I declare that I am free of Covid-19

GDPR *

Yes, I acknowledge the privacy policy

CONTRAINDICATIONS OF MASSAGE

Massage therapy appears to have few serious risks — if it is performed by a properly trained therapist and if appropriate cautions are followed. The number of serious injuries reported is very small. Side effects of massage therapy may include temporary pain or discomfort, bruising, swelling and a sensitivity or allergy to massage oils.

Cautions about massage therapy include the following:

Vigorous massage should be avoided by people with bleeding disorders, low blood platelet counts and by people taking blood-thinning medications such as Warfarin.
Massage should not be done in any area of the body with blood clots, fractures, open or healing wounds, skin infections, weakened bones (such as from osteoporosis or cancer) or where there has been a recent surgery.
Although massage therapy appears to be generally safe for cancer patients, they should consult their oncologist before having a massage that involves deep or intense pressure. Any direct pressure over a tumor usually is discouraged. Cancer patients should discuss any concerns about massage therapy with their oncologist.
Pregnant women should consult their health care provider before using massage therapy.
General Contraindications

For certain medical conditions, massage therapy is generally contraindicated, or should be avoided at the time.

These include:

systemic contagious or infectious diseases, including the common cold
acute conditions requiring first aid or medical attention
severe unstable hypertension
significant fever.
Local Contraindications

For the following conditions, massage therapy is locally contraindicated, or the affected areas are to be avoided:

Acute flare-up of inflammatory conditions such as rheumatoid arthritis
Deep vein thrombosis
aneurism
frostbite
local contagious or irritable skin conditions
open sores or wounds
recent surgery
recent burn
varicosities
malignancy

Massage therapy does not constitute medical treatment and is not a substitute for a medical examination or diagnosis. If you are dealing with a serious health condition check with your health care provider before seeking massage therapy and make sure you inform your massage practitioner of any health conditions that may affect the work.