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MFR Hands

Occupational Therapy Wellness
Therapist: Taranjit Grewal
Phone: 713-791-4636
Email: [email protected]
Website: https://mfrhands.com

Consent for Treatment, Communication, Conditions of Service and Financial Agreement

What is Myofascial Release (MFR)?

Myofascial Release (MFR): 'Myo' refers to muscle and 'fascia' is the deep connective tissue that connects every single structure in our bodies- down to the cellular level. MFR is a holistic and gentle application of sustained pressure into the tissues that are hot, hard or tender (known as fascial restrictions).

Risks & Benefits

MFR is a very low-risk treatment method. The therapist is trained to evaluate and identify areas of restriction. The therapist then works with your body to initiate and encourage your body's self-healing process. With sustained pressure over time, the tissue can release pressure on the body's tissues, muscles and organs. It also helps bring fascial reorganization and rehydration, helping you become more in tune with your body, eliminate pain, have better alignment, help your body function better, enhance your ability to relax and return to a pain-free active lifestyle.

Research shows that MFR is effective in:

Patients have also reported improved sleep, better recovery from exercise, better sitting, standing and walking tolerance and a general sense of peace and well-being. The role of the MFR therapist is to assess, educate and empower you to better understand and redefine your relationship with your mind and body.

After treatment you may feel energized, tired or therapeutic pain (similar to soreness after working out) which may last 1-3 days.

The Healing Process

As you go through your treatment sessions, you will go through a healing crisis, which means your body will reignite its inflammatory response so that your body can clean up the tissue and help you to deeply heal.

True healing doesn't occur in a linear fashion. It is often messy, disorganized and your mind will try to avoid it. Oftentimes, you have to walk through the pain of the trauma or past injury to experience authentic healing (feeling is healing).

It is important to feel the sensations while being mindful, patient and allowing your body to go through the process. It is important not to avoid the process or disregard what your body is communicating to you. This journey to wellness and wholeness is a process that can include great improvements and some setbacks as your body recalibrates to the changes.

It is very important for you to communicate your questions, concerns and feedback with your therapist, so we can come up with the next course of action. Myofascial Release treatment provides long term relief for a variety of ailments. When we learn to take care of our physical, mental, emotional & spiritual needs daily, we can prevent the severity of future dis-ease. It is strongly encouraged to receive routine MFR sessions as well as perform self-treatment techniques to receive the full benefits of MFR therapy.

Consent to Evaluation and Treatment

Evaluation

I understand that the evaluation includes providing a medical and social history, physical assessment and a subjective self-report. I agree to allow the therapist to perform physical assessments required to identify areas of concern and explore how it affects engagement in my daily activities and wellness.

I understand that assessments require the therapist to perform a visual inspection of exposed body areas or palpate body parts that may be sensitive or painful. I also understand that there are some risks in participating in a physical evaluation, including but not limited to developing soreness, increased pain, new pain in different areas, an aggravation of existing symptoms or of a new injury.

I understand that if I am uncomfortable at any time during the evaluation, I can let the therapist know and may refuse to continue the evaluation at my choice. If I refuse to participate in any part of the evaluation, I understand that the therapist may not be able to provide the most appropriate plan of care.

I understand that receiving MFR through MFR Hands is not intended to diagnose or treat illnesses, diseases or conditions, does not provide medical examination, treatment and intervention for disease management and medical conditions. It is recommended that you work with your primary doctor and medical team for any physical or mental illness, diagnosis or condition you may have.

I have informed the therapist of all my known physical and medical conditions and medications. I will keep the therapist updated of any changes. I understand that the therapist may ask for a referral from a licensed referral source, during or after the evaluation, when it is necessary, to continue treatments.

Treatment

I acknowledge that the therapist has informed me of the potential risks and benefits of myofascial release for wellness and health promotion and I have been given an opportunity to have all my questions answered. I hereby agree to participate in and consent to receive myofascial release therapy for wellness and health promotion.

I understand that the response to myofascial release varies from person to person and sometimes may result in increased pain, an aggravation of existing symptoms or of a new injury. Therefore, I agree to inform the therapist of any change in my symptoms and function so my treatment plan can be adjusted accordingly.

I understand that I may decline therapy at any time by informing the therapist of my desires/concerns and that my refusal may result in a termination of my session. I also understand that although we have set a proposed plan of care and goals, the therapist has made no guarantees that any particular outcomes will result from myofascial release therapy.

I understand that MFR Hands does not perform spinal manipulations. I understand that the MFR sessions provided to me by the therapist are for the purpose of wellness and health promotion. I understand it is necessary for the therapist to use therapeutic touch, directly on the skin and observe my body in different planes to conduct this process during remote sessions.

I understand that the therapist reserves the right to refuse or terminate a session for anyone whom the therapist considers having a physical or mental condition for which myofascial release is contraindicated. I understand that I have to tell the therapist if there is pain at any point during the session.

Professional Conduct

I understand that any illicit or sexually suggestive remarks, advances or behavior made to the therapist will result in immediate termination of the session and the therapeutic relationship with MFR Hands. No further sessions will be scheduled.

I understand that any rude, offensive, derogatory remarks or behavior, or false claims made about me during a session or outside of a session, whether in person, on the phone, on video call or on the internet, will result in immediate termination of the session and the therapeutic relationship with MFR Hands. No further sessions will be scheduled.

Informed Consent

I have read and understand the benefits and risks involved in participating in the evaluation and treatment. I consent to the evaluation and treatment, accept all associated risks involved and agree to fully cooperate and participate in the proposed plan of care. I freely and voluntarily give my informed consent to MFR Hands and the therapist to perform MFR therapy necessary in helping me achieve a healthy, active lifestyle.

Policies and Procedures

Remote Session Guidelines

Since MFR Hands provides remote sessions, the following guidelines apply:

Client Rights and Responsibilities

The client has the right and responsibility to ask any questions or express any concerns they may have about the Myofascial Release session. The therapist will explain the process and answer any questions within the scope of MFR therapy practice.

The client has the right and responsibility to give feedback to the therapist at any time before, during or after the session. Both therapist and client have the right to terminate the session at any time if they feel physically or emotionally uncomfortable or unsafe.

An emotional release may happen during a Myofascial Release session. This is normal and not cause for alarm. The therapist will do everything possible to help the client feel safe and supported through the experience, and the client has the right to communicate these needs to the therapist.

Package Terms

If a package of services is purchased:

Communication

Communication (including appointment reminders) with the therapist will occur through email, text, phone or video messaging. Scheduling is managed through Acuity Scheduling system (taranjit.as.me or vervebody.as.me).

Late Arrivals

All sessions begin and end on time. If you arrive late to your remote session, your session may be shortened in order to accommodate others whose appointments follow yours. Depending upon how late you arrive, your therapist will then determine if there is enough time remaining to start a treatment. Regardless of the length of the treatment actually given, you will be responsible for the "full" session. Out of respect and consideration to your therapist and other clients, please plan accordingly and be on time.

Cancellation Policy

24 hour advance notice is required when canceling an appointment. This allows the opportunity for someone else to schedule an appointment. If you are unable to give 24 hours advance notice you will be charged the full amount of your appointment. If the client has purchased a package, the session will be deducted from the remaining package.

Continuity of care is an important part of the therapeutic process. Frequent cancellations and/or no shows may cause long periods between therapy sessions and impact the effectiveness of treatment. Unexpected events and emergency situations that cause interruption to your scheduled session will be reviewed on a case-by-case basis.

No-Show Policy

Anyone who does not arrive to their scheduled session will be considered a "no-show" and will be charged for the full payment of their session. If the client has purchased a package, the session will be deducted from the remaining package.

Payment Agreement

Payment Terms

MFR Hands is a fee for service practice. Service is considered within the scope of wellness and health promotion, preventative care and maintenance for better performance in everyday life activities.

Payment is due in full at the time of booking through the online scheduling system.

Pricing Structure

No tipping required - All pricing is all-inclusive.

Insurance and Third Party Payment

MFR Hands is not responsible for any insurance or benefits payments, third party interest or the resolution of any legal action or lawsuits in which you may be involved. All services are provided on a cash-pay basis through online payment at time of booking.

Collection and Storage of Personal Information

Storage and collection of client information is in accordance with (HIPAA) Health Information Portability and Accountability Act. Your file will be kept for 7 years in compliance with health record maintenance requirements.

Any information shared via electronic platforms, such as email, text, or video conferencing platforms, are not protected by HIPAA and therefore it is recommended to limit personal health information communication via these avenues.

Limits of Confidentiality and Memorandum of Understanding

I understand that, as long as I am over age 18, all records and communications with MFR Hands are confidential and may not be disclosed without my written consent. There are, however, certain limitations delegated by the law such as:

Client Signature

By booking an appointment with MFR Hands, I acknowledge that I have read, understand, and agree to all terms outlined in this Consent for Treatment, Communication, Conditions of Service and Financial Agreement.

Client Name: _________________________________
Date: _________________________________
Signature: _________________________________