To the Clients of Reflexology
You need to know that:
1. A Reflexologist is not a doctor.
2. A Reflexologist does not practice medicine.
3. A Reflexologist does not diagnose or treat for a specific illness.
4. A Reflexologist does not prescribe or adjust medication.
5. Reflexology is not a substitute for medical treatment, but is a complementary modality to most types of therapy.
6. Reflexology is a clothed modality. Only the shoes and socks are removed for a session.
7. All client information is confidential, and that the reflexologist conducting your session, is bound to such confidentiality in accordance with the ARCB (American Reflexology Certification Board) Code of Ethics, and Professional Standards.
Studies show that:
1. Reflexology promotes balance and normalization of the body naturally.
2. Reflexology reduces stress and brings about relaxation.
3. Reflexology stimulates circulation and the delivery of oxygen and nutrients to the cells.
By signing this form, I certify that the above information is correct to the best of my knowledge. I give my
consent to a reflexology session. I understand that I may discontinue a session or sessions at any time
for any reason, and if I feel at all uncomfortable I should tell my reflexologist.
If I have been diagnosed by a licensed health professional as having any disease, injury or other physical
or mental condition, I understand that I should inform the person who made that diagnosis about the
reflexology session I am receiving. If I have any communicable condition or condition that may
contaminate the therapy area, I may be refused service until such time as that condition is certified as
I understand that this reflexology session should not be construed as a substitute for medical treatment
and that I should see a physician, chiropractor or other qualified medical specialist for any mental or
physical ailment. I fully understand that the reflexologist conducting this session is not an allopathic
doctor, psychologist, or psychiatrist and does not portray himself/herself to be. I agree to keep the reflexologist updated as to any changes in my medical profile prior to any future sessions and understand
that there shall be no liability on the reflexologist’s part, should I fail to do so.
All client information is confidential.