Header for Alicia Mutch | Poppies Reaching Towards the Sky | Hypnotherapy and Massage Therapy | Healdsburg, California

Personal Information

Health History

Informed Consent

It is my choice to receive massage therapy. I understand that the treatment is being given for the well being of my body and mind. This includes, but is not limited to: stress reduction, relief from muscular tension, spasm or pain, increased range of motion, and for increasing circulation. I agree to communicate with my practitioner any time I feel like my well being is being compromised. I understand that massage therapists 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 informed the massage therapist of all my known physical conditions, medical conditions and medications, and I will keep the massage therapist updated on any changes.
I understand and agree to the terms outlined in the Informed Consent above. By typing my name above, I acknowledge that this serves as my electronic signature, and I consent to the terms stated herein.

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