Download MOLLY PEARL, CO. CONTRAINDICATIONS DISCLAIMER

MOLLY PEARL, CO. CONTRAINDICATIONS DISCLAIMER
Dear Massage Client,
Massage may be contraindicated in the presence of certain medical conditions. In certain cases, an
authorization from your healthcare provider may be required in order to receive massage services in our
clinic.
Doctor's authorization required:
• PeripheraL arterial disease
• Cancer - currently being treated
• Coronary artery disease
• Epilepsy
• Hepatitis
• Insul'in-dependent diabetes with numbness in extremities and/or kidney dysfunction
• Pregnancy
Licensed Massage Therapists are not trained to provide massage for people with these conditions. and
you will not be able to be treated by Molly Pearl. Co.:
• Active tubercuLosis
• Acute bronchitis/ emphysema
• Acute lupus
• Acute rheumatoid arthritis
• Cellulitis (streptococcal B)
• Cystitis/nephritis (bLadder/kidney infection)
• GLomeruLonephritis (inflammation of the kidneys)
• HemoLytic anemia
• Infectious disease
• Influenza
• PhLebitislthrombophlebitis/embolism (blood clots)
• Septic arthritis
• Shingles
• Skin disease
Molly Pearl Owen, LMT #18158 may cancel a scheduled massage at her discretion due to the above
conditions or other conditions that may put the client or therapist at risk.
I have stated all my known medical conditions and will keep the clinic updated with regard to any changes.
Client signature: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Molly Pearl, LLC.
Date: _ _ _ _ _ _ __