top of page

New Patient Form - Ayurvedic Marma Massage

Sex
Male
Female
Are you pregnant?
Yes
No
N/A
Have you had any surgery within the last 12 months?
Yes
No

General disclaimer:

1.      Consultation and medical advice: Ayurvedic marma massage is a traditional therapy intended for wellbeing and relaxation. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek advice from your physician or other qualified health practitioner.

2.      Disclosure of health conditions: It is important to disclose all known medical conditions, medications, and any other health concerns. I cannot be held responsible for failure to disclose such information.

3.      Contraindications: The following conditions are generally contraindicated for marma massage. If you are experiencing any of these conditions, please inform me immediately:

a.      Pregnancy

b.      Infectious diseases

c.      Severe illness (eg advanced cancer, severe heart condition)

d.      Fever

e.      Acute inflammation or recent injuries

f.        Varicose veins or DVT

g.       Severe skin conditions

h.      Recent surgery

i.        Severe psychiatric conditions

j.        Blood disorders or those on anticoagulant therapy

k.       Hypersensitive to touch

4.      Confidentiality: All information provided will be kept confidential and will not be shared without your explicit consent, except as required by law.


By completing and signing this form, you acknowledge that you have read, understand and agree with the above disclaimer. You confirm that the information provided is accurate and complete to the best of your knowledge and that you voluntarily consent to receiving this treatment.

bottom of page