Oncology Massage Consultation Form

Thank you for taking a moment to complete this form before your session.  It helps me understand the cancer diagnosis you have been given and what treatment you  may be undergoing (or about to undergo).  The information you give me will be helpful to know what’s going on in your body, what your goals are, and how I can make sure that the massage you receive will support you. 

It is helpful to know if you will be working during your treatment so that we do not forget to support this area of your daily life
Staying as active as your can during your treatment can be helpful.
It's important to have contact details, including a phone number, to give your medical team details about your massage if this is helpful for you (with your permission only to comply with GDPR)
Give details of any treatment you may have already received or will be undergoing in the future.
The medication you will be given may change during your treatment. We can update this where necessary
These can change as you undergo treatment and can include symptoms from your cancer diagnosis, your current treatment and how you are feeling
Although not always applicable, please let me know if you have any medical devices that have been attached to your body for your treatment and where they are located. This helps me to adapt your massage to give you the most comfortable experience.
If you have or are receiving this type of treatment, it is important to know where the treatment has been given in your body. This is because your skin in these areas will be sensitive and fragile and I will avoid work on them.
During massage sessions the focus will be on your wellbeing, recovery inbetween your current treatment and mitigating any sideffects you may be experiencing. But it is also important that we work towards any goals you may have.
I understand that massage therapy is not an alternative method for tumour reduction. Nor does it provide a cure or substitute for medical treatment or medications. I also understand that it is recommended that I concurrently work with my Primary Caregiver for any condition I may have. I am aware that the massage therapist does not diagnose illness or disease, does not prescribe medications, but is intended to enhance relaxation, reduce pain caused by muscle tension, increase range of motion and improve a sense of wellbeing. The general benefits of massage, possible massage contraindications and the treatment procedure have been explained to me. 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 that there shall be no liability on the practitioner’s part due to my forgetting to relay any client information. If I experience any pain or discomfort during the session, I will immediately communicate that to the therapist so the treatment can be adjusted. I consent to Poise Sport and Remedial Massage holding my personal information as determined by the General Data Protection Regulation policy for 5 years.