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Massage Consent Form

Sports Massage

Please fill out this form if you are attending a sports massage appointment.

  • Using the diagram below as a guide please fill out the following fields to indicate any pain, stiffness or numbness. Areas of Pain Image supplied by Burrell Education.
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  • I understand that the massage I receive is provided for the basic purpose of relaxation and relief of muscular tension and myofascial pain conditions suitable for treatment using soft tissue therapies.

    If I experience any pain during this session, I will immediately inform the therapist so that the pressure and/or strokes may be adjusted to my level of comfort. I further understand that massage should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or qualified medical specialist for any mental or physical ailment of which I am aware.

    I understand the massage therapists are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Because massage should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly.

    I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapist’s part should I fail to do so.

    I acknowledge that should I be late for my appointment the therapist has the right to alter the length of my massage to suit the needs of the office schedule.

    I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.

What do my clients say?

"This course helped me improve my core strength and pelvic floor connection. What I wasn't expecting was to improve my diet but after listening to all the information and advice I have made changes and this has stopped the bloating I was experiencing. I also had a split in my abs after pregnancy and when Charlotte checked them again at the last session they had come together so this was a great result."

Knowing Charlotte was there for me and the support of the group: understanding my core much better and discovering new things about my body; the ongoing advice, encouragement, honesty and passion about women's health from Charlotte; and the bag of goodies!

"Charlotte’s bootcamp has been really good fun – hard work, but good fun! It’s a great feeling to know that by 7.15am, you’ve already done a fantastic workout and you can get on with the rest of your day, feeling a little bit smug actually!"

"I started buggy fit 7 weeks post-partum and was so impressed with Charlotte's knowledge around exercising during and after pregnancy - something I had not found until this point. The classes are great - varied and fun, and Charlotte has a warm and personable character and is very passionate about what she does.  Most importantly, you aren't allowed to do too much, something that I know would have happened if I had started exercising without expert guidance. Charlotte really stresses the importance of taking things slowly, strengthening your pelvic floor and also emphasises the immense impact pregnancy has on your body.  I'm now 5 months post-partum and feeling much stronger. Thank you, Charlotte!"
"I have been coming along to Charlotte's Pilates and Buggy Fit classes since I was 10 weeks post caesarean. Both classes have been really good for developing my core strength, stretching out my tired back and helping me on my way to returning to my pre-pregnancy fitness levels. I especially like the informal, fun atmosphere at Buggy Fit and being outside with other mums and babies."

"I had a significant diastasis after the birth of my third child, mild stress incontinence and lower back pain from lifting my baby. Since completing the Holistic Core Restore © (HCR) programme my diastasis has almost closed up and I have no incontinence or back pain. Charlotte was extremely motivating and I felt well supported.

She understood my needs as she has a baby the same age. I found the homework videos easy to follow and short enough to realistically fit in to my busy day.

My goal from the HCR was to get back to running fitness. I have achieved this with Charlotte's help and feel so much better for it. I have also lost weight and feel toned and fit."

"My core muscles feel tighter and my stomach muscle gap has definitely reduced. My general well-being and health has definitely improved through the added chats about nutrition amongst other things. I feel much more motivated to lead a healthier lifestyle.

I enjoyed the personal touch shown by Charlotte through the WhatsApp group (as well as in class). She kept me motivated with the nutrition and the daily exercise homework."

"I enjoyed the holistic approach. So it was not only about doing the exercises but encompassed a whole body approach – diet, rest, self care – the classes felt like a safe space.

I also enjoyed the exercises that were challenging and a good workout."

"I needed to strengthen my pelvic floor due to prolapse issues – I no longer have any major issues and can identify my muscles easily and can positively use them!

Charlotte was very well informed and passed on some great information and advice and was brilliant at making sure we were doing the exercises in the right way."

"I loved the holistic, rounded approach. The energy of the instructor, Charlotte, and the fact that, after nearly a year of devoting all my time and energy to my new baby and the household in general, I had an hour a week to spend on my own health and wellbeing.

The course exceeded my expectations – as many women as possible should do it!"

"I feel the structure of the course is really good and I enjoyed the talks at the end of each session, which were really informative. Charlotte created a relaxed environment for us to be able to ask questions and was very supportive."