Oncology Massage Intake Form

Oncology Massage - Consent and Release Form

About Oncology Massage

Cancer massage, also called oncology massage, refers to massage therapy that is offered to people with cancer. It is not used as

a treatment for cancer, but rather an integrative therapeutic intervention to relieve some symptoms associated with cancer, or

side-effects of certain cancer treatments. Massage therapy may help relieve symptoms such as pain, muscle tension, anxiety

and depression, as well as stimulate the release of endorphins and lower stress hormones. It is also useful in improving the

patient's sense of wellbeing and quality of life. Massage for people with cancer may involve the use of several types of massage

and bodywork such as Swedish, aromatherapy, myofascial release, shiatsu, and trigger point therapy.

Contraindications for Oncology Massage

In addition to the standard contraindications for massage, cancer massage has additional contraindications and precautions.

Whether or not is is safe to proceed with massage for an individual with cancer depends on numerous factors including: type

of cancer, stage of cancer, current symptoms, comorbidities, and other treatments that the patient is receiving. The following is

a partial list of common conditions which are considered contraindications for cancer massage therapy:

• Blood Clots

• Bleeding disorders

• Pitting edema

• Heart disease

• Infections

• Skin lesions

• Impaired immune function

• Unexplained symptoms

Please Read and Initial Each Item Below

I further understand that massage is not a substitute for a medical examination or treatment, and that I should see a physician

or other qualified health specialist for any mental or physical ailment of which I am aware. I understand that massage therapists do not diagnose illness or disease, and nothing said during the treatment should be construed as such. My consent is informed and voluntary and I understand that I may withdraw my consent at any time except for actions already taken.

By signing this form I agree with the statements above and give my consent to proceed with massage therapy.