Informed consent is an important component of the intake process for new massage therapy clients. A signed consent form is a legal document that represents the client’s understanding of the services to be provided, and the assumption of risk. It is also an element of successful communication in a therapeutic relationship between the massage therapist and client.
What is informed consent for massage therapy? Informed consent is a client’s voluntary authorization, agreement or permission to proceed with the proposed massage therapy services. The consent form documents that specific criteria have been met. These criteria confirm that the client’s permission is voluntary, the client is competent to make their own decisions, and the client understands the proposed treatments, benefits, risks and alternatives.
This article provides details about what informed consent is, why massage therapists should always get informed consent before providing services, and how to apply this to your practice. Massage therapists and students need to have a good understanding of the concepts involving client consent for their own practice and when preparing for the MBLEx.
Why do massage therapists need informed consent?
Massage is a relatively safe health and wellness intervention, so why is informed consent even needed? There are two main reasons:
- To protect the client
- To protect the therapist
Providing the necessary information that allows a client to make an informed decision can protect the client from injury, or from receiving a service that they may not have really wanted. It allows the client to weigh the risks and rewards, pro’s and con’s, costs and benefits for themself.
Informed consent may protect a massage therapist legally in certain circumstances because it demonstrates that the client agreed to receive the service after the therapist made a deliberate effort to provide the client with all the information they needed to give agree. However, in order to protect the therapist from liability, the consent form must include a signed release or waiver section, or be accompanied by a separate liability release or waiver form.
It is important for therapists to understand that even a signed liability waiver or release will not prevent legal consequences if there is malpractice, negligence or intent to cause harm. Informed consent with a liability waiver is one component of a comprehensive risk management strategy, along with massage liability insurance, and continued competency training. Informed consent is a fundamental ethics and legal component of any health and wellness practice.
Massage practitioners should require ALL clients to give informed consent before providing them with massage therapy or bodywork services. This applies to therapists and massage businesses that provide clinical or medical massage, as well as therapists that provide general relaxation massage, energy work, chair massage, and all other forms of bodywork.
Other reasons why massage therapists need informed consent from clients:
- To establish good therapist-client communication and rapport
- To ensure accurate client expectations
- To avoid surprises or misunderstandings
- To foster trust and set the tone for a therapeutic relationship
- To reinforce client bodily autonomy and empower the client
- To support shared decision-making
- To encourage therapist-client collaboration
Types of massage consent
The general term consent simply means permission for something to happen, or a voluntary agreement to do something. However there are different types of consent that massage therapists and other health service providers should be aware of.
Informed consent
Informed consent, as defined above, is permission which has been given after certain conditions have been met. The primary condition is that the decision-maker (i.e. patient or client) has been informed about the risks, benefits, costs, alternatives, and any other information that they need so that they can make an informed decision. We’ll cover all the criteria of informed consent in the next section.
The following types of consent are not based on meeting certain requirements like informed consent is, but rather the way in which the consent is given.
Verbal consent
Verbal consent is permission that is given orally. While this type of consent is generally not sufficient to initiate service, it can be an acceptable form of consent for small and relatively inconsequential permissions. For example, if you ask a client during a massage session if they would like the table warmer turned off, or if they would like more or less pressure, a simple “yes’ or “no” is sufficient. There is no need to get written or informed consent for this. It is however a good idea to document in your massage treatment note if you were given verbal consent for something such as increasing pressure or adding a new massage modality mid-treatment.
Non-verbal consent
Non-verbal consent is communicating permission with a clear gesture such as nodding “yes” or giving a ‘thumbs up’ sign. Like the verbal consent, non-verbal consent is not sufficient to initiate service, but may be used for small, low-risk permissions. For example, if a client gives you a ‘thumbs up’ sign after you ask them if they would like to listen to music, or would like some lavender oil in the diffuser. Non-verbal consent should be documented in your SOAP note.
Written consent
Written consent is permission that is given through the use of a signed written document. Informed consent is typically requested using a written document. ***Just because consent is given in writing, it does not necessarily mean that it was informed consent.
Implied consent
Implied consent is permission that is given based on a person’s actions or the situation. For example, a massage therapist who is providing chair massage at a public event may infer that a person is giving their implied consent to receive massage if the person hands the therapist payment for a 10-minute massage and then sits down on the massage chair. Implied consent is also given when a client allows something to continue. For example, as long as the client remains sitting on the chair or lying on the table, they are giving you implied consent for the session to continue (as long as they are physically and mentally capable of getting up if they wanted to). Similarly, if you make a small change like an increase in pressure, and the client does not give verbal or non-verbal signs of discomfort, it is implied that the client consents to this increase in pressure. Implied consent is a weak form of consent. *Be sure to frequently check in about client comfort and ensure that they know that feedback is always welcome.
Express consent
Express consent, also known as explicit consent, is permission which is directly expressed, or communicated with the provider. This could be in writing or verbally. Expressed consent is not necessarily informed consent. Each of the criteria listed in the next section must be present for it to be considered informed consent.
***The ideal type of consent for a massage therapist to receive before providing services is informed consent that is expressly given in writing by the client or their legal guardian. This becomes even more important when the treatments are more complex, or when there are more risks of significant side effects.
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5 Criteria of informed consent for massage therapy
Informed consent involves more than just telling a client what you’re planning on doing and why. There are five basic criteria or requirements that must be met in order for client consent to be considered informed consent. These criteria are the same whether a person is giving their informed consent to receive massage therapy, physical therapy, or any other medical treatment. Similarly, medical researchers are also supposed to get informed consent from all research participants before allowing a person to participate in a trial.
Voluntary decision making
A client’s informed consent must be given voluntarily. It cannot be forced, coerced, unduly influenced or obtained under duress.
Mentally competent
Only a competent adult with the capacity to understand all of the information can give informed consent. This decision-capacity means that the client is able to understand the risks, consequences, benefits, costs, and everything else involved with the treatment so that they can come up with a reasonable and logical decision regarding their participation. In most circumstances, children under the age of 18 are considered to not have the capacity to make their own health/medical decisions or enter into a contract legally (in the US). This is why their parent or legal guardian must also give their consent. Clients with mental incapacities such as dementia or other cognitive issues may also require a legal guardian or medical power of attorney (POA) to sign for them. Also, consent forms should not be signed by clients that are currently under the influence of mind altering drugs that can affect their decision-making (this is also a massage contraindication).
Disclosure of relevant information
The massage therapist must present accurate, thorough and relevant information about the proposed treatments. A client may have a misconception or a different expectation about the services being offered. So the therapist must educate the client about what the massage or bodywork session will involve. For example, the therapist needs to inform the client about the assessment process, the techniques that will be used, what the client should wear, how the client will be draped, what products may be used, the general flow of the session, etc.. The point is that the client needs to know everything necessary for them to make an informed decision. *Much of this information will be provided to the client verbally, as the therapist explains the treatment and answers questions. However, you may want to include some information, such as a list of risks, both verbally and in writing on the consent form.
Informing a new client about all of this will also improve the client’s experience because it will put them at ease and remove uncertainty about this new experience. Taking the time to educate the client about what to expect is especially important if you offer a less common type of massage or bodywork. Or if you typically include stretches, energy work, or other less common techniques that the client may not expect or want. You don’t want the client to be unpleasantly surprised! *Tip: It helps to have clear descriptions of your services on your website so that clients will come in already having a good understanding of the services that you offer.
Disclosed information should include the following components:
- Description, nature and purpose of the recommended treatment
- Disclosure of possible risks and potential adverse reactions of this treatment
- Indications and contraindications of massage or bodywork treatments
- Goals and expected benefits of this treatment
- What are the treatment costs (how much money and time)
- Suggestions of alternatives treatment options
- Potential consequences of forgoing treatment
- Massage scope of practice and limits of massage
- Disclosure of therapist training, credentials and relevant experience
Comprehension of terms
The client must understand the proposed treatment plan and everything that is involved. In addition to being given all pertinent information, clients must be given the opportunity to ask questions about the recommended intervention. Then the client must get their questions answered so that they can make a well-considered decision about whether or not they agree to receive the massage services.
Clients must also acknowledge that they understand their right to refuse, decline or stop treatment at any time and for any reason. This includes before the treatment begins and during the treatment.
Consent
The final component of informed consent is getting the client’s actual permission or agreement with the proposed treatment. For new massage clients, it is ideal to get written informed consent. But for small, low-risk treatment decisions, verbal consent is generally sufficient.
Massage informed consent form examples and templates (PDF)
The following are some examples of informed consent forms that you can download to use in your massage practice. You can print out the forms to give to new clients along with their other intake documentation. Or you can post an electronic version of the form on your website or upload to your practice management software system.
You can also use the consent forms here as templates to create a custom form that meets the specific needs of your practice. There are an endless number of ways that a consent form can be written, as long as it has all the important components that need to be included. See our massage forms page to download these consent forms (PDF) as well as other client documentation.
General Informed Consent
Hot Stone Consent Form
Prenatal Massage Consent
Cupping Consent Form
Terminology and concepts of informed consent
Client rights
Client rights are a broad set of rights that clients and patients of health service providers are entitled to. The overall concept of client rights is fairly consistent throughout the healthcare industry, but are often presented a little differently depending on the organization and the setting (e.g. hospital, outpatient, social work, massage, skilled nursing, etc.). Standard massage client rights include the right:
- To be treated with dignity and respect
- To be fully informed about services and treatment options
- To refuse treatments or procedures
- To confidentiality and privacy
Liability
Liability is defined as any legally enforceable obligation or responsibility.
Liability waiver
A liability waiver is a legal document in which the client, patient or participant releases or relinquishes a known right, claim or privilege to pursue a claim in a certain set of circumstances. A waiver is often split into two sections, an “Assumption of Risk” section and a “Release” section. The “Assumption of Risk” section provides details of the inherent risks of the activity, and performs a role similar as the informed consent form. The “Release” section must be included and signed if the goal is liability protection.
Limits of massage
Limits of massage refers to the reasonable limitations of the benefits of therapeutic massage. For example, it is not reasonable to expect that massage can cure cancer, reverse vascular damage, or correct a chronic problem in one session.
Right of refusal
The client’s right of refusal refers to each client’s inherent right to refuse a particular massage treatment or to refuse massage services entirely. It is up to the massage therapist to make sure that each client fully understands their right to decline, refuse or stop a treatment at any time.
Risk
Risk refers to the possibility or likelihood of harm, loss or an adverse event. For example, common risks associated with massage therapy include the risk of bruising, soreness, and soft tissue damage.
*See our glossary of massage terminology to learn more massage terms.
Common questions about informed consent for massage therapy
Is informed consent required for massage therapy?
The short answer is, it depends. Some massage therapists may work in a city, state or local jurisdiction that requires a therapist to obtain informed consent from clients. Or they may work for a particular massage business, or belong to a certain association (e.g. ABMP), or offer a certain type of bodywork that requires consent. These entities may also have specific requirements about what information must be disclosed to clients. But for many massage therapists, there is no external regulatory entity looking over their shoulders to make sure that they are getting informed consent. It is, however, always recommended and is considered best practice to get informed consent before providing massage services. And since it is easy and beneficial to the client and the therapist, there is no reason not to fully inform clients and obtain their consent.
What is PARQ?
PARQ is an acronym that describes the elements that should be included when obtaining informed consent from a massage client.
- P = Procedures. Thorough description of the massage or bodywork procedures to be provided upon client consent.
- A = Alternatives. Alternatives to massage such as self-care techniques, physical therapy, acupuncture, chiropractic, RICE, etc.
- R = Risks. Description of risks associated with the proposed treatment. For example, risk of bruising, soreness, or allergic reaction.
- Q = Questions. Allow time for the client to ask questions and receive satisfactory answers.
When should a massage therapist get informed consent from a client?
This is a good question! The short answer is that the therapist should receive client consent before any services are provided to the client, including the client assessment. A new consent form should also be provided if there are any changes or additions to the treatment plan.
The problem with having a massage consent form signed during the intake process is that the treatment plan has not been established yet. So at this point, the therapist does not know what type of massage, techniques or modalities will be used. This means that the therapist would not yet know what what information they need to provide to the client so the the client will have the necessary information to make an informed decision. This may not be an issue when providing a general and standard relaxation massage. But it could be an issue for a therapist that will be treating specific client complaints or offering “medical” massage. In these cases, the therapist could get a basic informed consent prior to client assessment, and then provide an updated consent form if other treatments with specific risks are indicated. For example, the assessment may indicate that vacuum cupping may be beneficial, but the risks/benefits/alternatives were not previously discussed or on the initial consent form. The same goes for new services that may be added to the clients plan of treatment several visits down the road.
What is the difference between informed consent form and a liability waiver?
An informed consent form is a written acknowledgement that a client, patient, participant, etc. understands and voluntarily agrees to participate and accepts the risks inherent with a particular activity. A liability waiver is a legal document where the person waives, releases or relinquishes a known right, claim or privilege to pursue a claim in a certain set of circumstances. Many massage therapy practices combine the informed consent and the liability waiver together on the same form.
Can a minor sign an informed consent form?
An informed consent document is a legal document that is only valid if it is signed by a competent adult.
Are there exceptions to informed consent requirements?
Consent is not needed in life-threatening emergencies, when the client is incapacitated and physically or mentally unable to provide consent. For example, a massage therapist does not need the client’s consent to provide CPR or first aid if the client has a heart attack, stroke, or is choking. Appropriate therapist response in these instances is generally covered under Good Samaritan Laws.
Summary
Massage therapists should always obtain written, informed consent from every client before providing massage therapy services for the client. This consent should be obtained before the initial client assessment, and updated if there is a change in the treatment plan. There are other types of consent such as verbal and non-verbal consent which also have a place in massage therapy. Informed consent must include the 5 main criteria: (1) voluntary, (2) client is mentally competent, (3) disclosure of relevant information, (4) client comprehends the terms, (5) consent is given.
*Nothing in this post is meant to be medical or legal advice. This is presented for informational purposes only. Please check your state laws and consult with an attorney on any questions about informed consent or liability waivers for your massage practice.