Emotional release bodywork and consultation sessions
Please inform Bianca of any medical conditions or medications that you might be taking. There is always some risk associated with any treatment. Some potential responses from Emotional Release Bodywork include pain, bruising, dizziness, fainting and aggravation of your condition. To minimise the above possible risks please tell your practitioner if you become uncomfortable or experience pain during treatment, if you bruise easily or are on any blood thinning medications, or feel light headed or dizzy during or after the treatment.
I understand that the aforementioned are possible significant risks and complications specific to my individual
circumstances that may have a bearing upon my decision to proceed with the proposed treatment. The
practitioner has explained the treatment options to me and will discuss with me during the treatment if he/she
makes any further changes to the treatment. The practitioner has explained the associated risk and possible
side effects with this treatment and potential risks or outcomes if the treatment is changed. The practitioner
has explained that I have the right to refuse treatment or changes to the treatment and that he or I have the
right to stop the psychosomatic treatment at any time.
I understand that I have the right to ask for further information on treatments that include breast, buttock or groin areas and refuse treatment of these areas at any time. If you have any question related to the treatment you are about to receive, please do not hesitate to ask your psychosomatic practitioner.
In accordance with legislative privacy act 1988, all information relative to your case is held in total confidence.
However, your consent is necessary to allow us to exchange information between practitioners within this
clinic. When appropriate, relative information regarding your case may be sent to other medical and health
care practitioners for proper and effective management of your condition.
This agreement about confidentiality continue after the client’s death unless there are overriding legal or ethi-
cal considerations. In cases where the client’s safety is in jeopardy any confidentiality agreements that may
interfere with this safety are to be considered void.
‘I declare that the information I have given is true and correct and take responsibility for informing my
therapist of any changes to my health. I can undertake treatment in this establishment without any adverse
effects. I understand the therapy being performed on me, and that it is not a substitute for medical advice and/
or treatment. I have been informed of any contra-indications and am willing to proceed with therapy.
CANCELLATION POLICY: If you wish to cancel or reschedule your appointment, can you please notify Bianca asap, Cancellations and rescheduling will occur a $55 fee. If cancellation of appointment is within 24 hours, full fee is payable.
SICKNESS POLICY: If either party feels unwell or develops symptoms, we will reschedule your appointment with no fee payable.
SANITATION AND HYGIENE: Our massage therapy policies on sanitation are that all equipment and linens that come in contact with the clients will be cleansed in an approved method.
Before and after each massage, the massage therapist's hands and forearms will be washed with hot soapy water and a disinfecting solution. Any breaks in the skin of the massage therapist will be covered with protective coverings.
The client will come to the massage therapy appointment clean. The client will inform the massage therapist of any breaks in the skin, and these areas will be avoided.
By Booking an appointment with Bianca Moeschinger online you have read and understand the information above and give your consent to commence treatment.