Maternity Massage Consultation Card

Over 36Gestational diabetesPlacental dysfunctionBlood clots/phlebitisVaricose veinsHeartburnCurrent infection/contagious diseaseBruise easily or bleeding disorderAbdominal cramping, miscarriagesFirst pregnancyFrequent headaches/migrainesSwollen feet or handsHigh blood pressureSuffer from epilepsy or seizuresBladder/kidney infectionMuscle crampsUterine bleedingPre eclampsia (toxaemia)

Prenatal massage therapy client release form

I confirm that:
*I have not experienced any of the complications listed above, which would make it unwise to have massage therapy
*I have not experienced any of the conditions listed, which would make it unwise to have massage therapy
*I am experiencing a low-risk pregnancy
*I am receiving medical care including regular check-ups throughout my pregnancy

I understand:
*that the massage I receive is for the purpose of stress reduction.
*that the massage therapist does not prescribe medical treatment, pharmaceuticals, nor do they perform spinal manipulations
*that it is you the client responsibility to inform of any changes to this information
*that if I experience any pain or discomfort I will inform the therapist immediately so the pressure can be adjusted

By signing this release I hereby waive Danielle Cuglietta from all liability past, present and future to massage & bodywork


Leave your jewellery at home, remove your contact lenses and bring your glasses for your return journey, rest or nap if necessary, drink plenty of water to help remove lymph and toxins.

Please Sign Here: