INFORMED CONSENT FOR ASSESSMENT AND TREATMENT OF SENSITIVE AREAS

PLEASE READ CAREFULLY

I, have requested assessment and/or treatment by Registered Massage Therapist(s) (RMT) for treatment of the clinically relevant areas indicated below (please check)

The RMT has explained the following to me and I fully understand the proposed assessment and/or treatment:

• The nature of assessment, including the clinical reason(s) for assessment of the above area(s) and the draping methods to be used
• The expected benefits of the assessment
• The potential risks of the assessment
• The potential side effects of the assessment
• That consent is voluntary
• That I can withdraw or alter my consent at any time.

I voluntarily give my informed consent for the assessment and/or treatment as discussed and outlined above.