Massage Consent Forms are essential legal documents required in Indonesia for professional massage therapy services, whether provided in healthcare facilities, spas, or wellness centers. These forms serve multiple purposes: documenting informed consent, collecting relevant health information, and ensuring compliance with Indonesian healthcare and data protection regulations. The document becomes particularly important in the context of Indonesia's dual system of modern and traditional medicine practices, where different types of massage therapies may be offered. The form helps protect both service providers and clients by clearly outlining service parameters, potential risks, and data handling practices, while meeting requirements under Health Law No. 36 of 2009 and Personal Data Protection Law No. 27 of 2022.
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1. Client Information: Basic personal details including name, date of birth, contact information, and emergency contact details
2. Health History: Medical conditions, medications, injuries, surgeries, and other health-related information relevant to massage therapy
3. Service Information: Description of massage service, duration, and general procedures to be performed
4. Risks and Benefits: Statement of potential benefits and risks associated with massage therapy
5. Client Acknowledgment: Client's confirmation of accurate information provision and understanding of the service
6. Consent Declaration: Explicit consent for treatment and acknowledgment of risks
7. Data Privacy Statement: Information about how personal data will be collected, stored, and used in compliance with Indonesian data protection laws
8. Therapist Declaration: Professional commitment statement and signature section for the massage therapist
9. Signatures: Dedicated space for client and therapist signatures, date, and witness if required
1. Pregnancy Declaration: Additional section for pregnant clients including specific trimester-related considerations and risks
2. Photo Consent: Optional authorization for taking before/after photographs for treatment documentation
3. Insurance Information: Section for insurance details if the service is covered by health insurance
4. COVID-19 Screening: Temporary section for pandemic-related health screening and protocols
5. Traditional Medicine Acknowledgment: Additional section when traditional Indonesian massage techniques are used
1. Medical Conditions List: Detailed checklist of medical conditions that may affect massage therapy
2. Service Price List: Schedule of available massage services and their corresponding prices
3. Anatomical Diagram: Body diagram for marking areas of concern or areas to avoid
4. Treatment Record: Form for documenting each massage session, techniques used, and client feedback
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