Free Consent Form Template

Consent Form

This consent form covers your 60-minute relaxation massage; we record your permissions and will contact you only if we need clarification.

1. Your full name (required)
2. Email address (required)
3. Date (required)
4. Sign here (required)

What you agree to

You will be seen by Giulia Montanari, Lorenzo Fabbri or Elena Righi. Cancellation fees set by us.

1. Confirm you consent to take part (required)
   • I consent and will notify of health changes
   • I do not consent
2. Permission to take treatment photos
   • Yes, for clinical notes only
   • Yes, for clinical notes and anonymised examples
   • No, do not take photos