ZEN CLINIC
Acupuncture Massage eBook
Unit A-1278 Shillington Ave.
Ottawa, ON, K1Z 8A4
Tel: 613-710-9555
Email: clinic1278@gmail.com
RMT CONSENT FOR ASSESSMENT AND TREATMENT
Informed Consent
Before assessment or treatment begins, my Registered Massage Therapist (RMT) will explain the proposed assessment and/or treatment and provide the information I need to make an informed decision.
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Nature of the assessment and/or treatment: I understand what assessment and/or massage therapy treatment is being proposed.
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Expected benefits: I understand the expected benefits of the proposed assessment and/or treatment.
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Risks and side effects: I understand the relevant risks and possible side effects.
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Alternative courses of action: I understand that reasonable alternatives may be discussed where applicable.
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Consequences of not proceeding: I understand the likely consequences of not having the proposed assessment and/or treatment.
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Questions and right to stop or modify treatment: I have the right to ask questions and may ask the RMT to stop or modify the assessment or treatment at any time.
I understand that consent is voluntary and applies to the assessment and/or treatment being proposed. I may refuse, change or withdraw my consent at any time. I understand that the RMT may re-confirm my consent during assessment or treatment and will obtain consent before changing the treatment plan.
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Sensitive Areas
I understand that separate written informed consent is required before assessment and/or treatment of sensitive areas, in accordance with CMTO requirements. This general consent form does not by itself authorize assessment or treatment of a sensitive area.
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Patient Acknowledgment
I confirm that the proposed assessment and/or treatment has been explained to me, I have had the opportunity to ask questions, and my questions have been answered to my satisfaction. I consent to proceed with the proposed assessment and/or treatment.