Health information
Please check anything that applies. This information is confidential and helps ensure the session is safe and appropriate for you.
Current medications
List any medications you are currently taking, if relevant.
Anything else I should know?
Injuries, sensitivities, areas of focus, emotional context — anything that might be helpful.
Informed consent
Please read and confirm each point below.
Nature of the practice. I understand that abdominal massage (Chi Nei Tsang) involves gentle and intentional manipulation of the abdomen and may also include work with the organs, diaphragm, and — in Karsai Nei Tsang sessions — the pelvic region. This work is therapeutic and non-sexual in nature.
Not a substitute for medical care. I understand that this practice is complementary and does not replace medical diagnosis, treatment, or advice. I have disclosed all relevant health conditions and medications.
Possible sensations. I may experience physical or emotional responses during or after the session — including mild discomfort, tenderness, or emotional release — which can be part of the process. I will communicate openly with the practitioner if anything feels too intense.
Right to withdraw. I understand I can ask for adjustments, take a pause, or stop the session at any time, without question.
Professional conduct. I trust that Alexandre Dandelion will maintain a safe, respectful, and professional environment throughout the session, and will follow standard practices of care.
Release of liability. By signing below, I release the practitioner from liability for any adverse reactions resulting from this session, provided that standard professional practices are followed and I have fully disclosed relevant health information.
Signature
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Your intake form is complete. I look forward to welcoming you to the session. If you have any questions beforehand, feel free to get in touch.