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Click ‘Get Form’ to open the lymphatic drainage consent form in the editor.
Begin by filling in your personal information, including your name, date of initial visit, address, age, occupation, email, and phone numbers. This information is crucial for your therapist to understand your background.
Next, provide emergency contact details and the name of your primary care physician. This ensures that your therapist can reach someone if necessary.
Answer the medical history questions honestly. Indicate any allergies, current medications, or medical conditions that may affect treatment. This section is vital for tailoring your therapy safely.
Review the waiver statements carefully. By checking these boxes, you affirm your understanding of the therapy's nature and agree to keep your therapist informed about any health changes.
Finally, sign and date the form at the bottom to confirm your consent for treatment. If applicable, a parent or guardian should sign for minors.

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How long does a lymphatic drainage last?

How long the results last? Results can last up to 10 days, depending on your metabolism and lifestyle.

What are 3 conditions that affect the lymphatic system?

Common infections that can cause enlarged lymph nodes include strep throat, mononucleosis, HIV infection and infected skin wounds. Lymphadenitis refers to lymphadenopathy that is caused by an infection or inflammatory condition.

Who needs lymphatic drainage?

Lymphatic drainage massage has been used for people with lymphedema, which involves swelling, generally in one of your legs or arms. The swelling is caused by lymph fluid that's collected in the soft tissues, due to genetic disorders, injury, infection, cancer treatment, or surgery. Symptoms of lymphedema include: Pain.

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What are some contraindications for lymphatic drainage?

Contraindications for MLD can be classified as general or region specific. General contraindications include cardiac edema, renal failure, acute infection, DVT, bronchial asthma or bronchitis, and active malignancy (relative).

How do I know if I need lymphatic drainage?

Signs You Need Lymphatic Drainage Massage Allergies and/or food sensitivities. Bloating. Brain fog. Chronic lethargy (persistent tiredness) Constipation. Depression. Digestive problems. Swollen lymph nodes.

What is manual lymphatic drainage good for?

Lymphatic drainage massage, also known as manual lymphatic drainage, is a gentle form of massage used to relieve painful swelling in your arms and legs caused by lymphedema. Lymphedema often affects people recovering from breast cancer surgery.

Who should get manual lymphatic drainage?

Lymphatic drainage massage has been used for people with lymphedema, which involves swelling, generally in one of your legs or arms. The swelling is caused by lymph fluid that's collected in the soft tissues, due to genetic disorders, injury, infection, cancer treatment, or surgery.

How much does it cost to drain lymph nodes?

On average, lymphatic drainage massage costs about $100 per hour of therapy in the United States. However, if you want your massage session to last longer, you'd have to pay more. An hour and a half of lymph drainage can easily cost you an excess of $50 to make $150.

Lymphatic drainage consent form 2025

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