My Email address is: __________________________________

PROFESSIONAL CONSENT:
I understand that the way I practice reflects on on fellow MT professionals. I, therefore, agree to be a cooperative MT, practicing in a way which helps build a professional infrastructure for all MTs, while in persuit of my own professional success.

Toward that, in informal speech as well as in formal presentation and published literature, I am proud to identify my profession as massage therapy (or MT), myself as a massage therapist, use the professional designation LicMT--or the equivalent legal professional designation in my area--practice in a client-centered manner, and adhere to professional conduct protocol. My goal is to develop my own office-based (individual or group) MT practice for which I will be solely responsible, or to be employed as a practicing MT in a professional setting. Before I begin the treatment portion of the first MT session, I agree to conduct an Initial Intake consultation with every new client and patient, taking essential notes for greater insight and future reference. If in private practice, I agree to set a professional fee schedule and--in any setting--refuse "tips" politely but firmly.

I agree not to impose any multi-level marketing of products, services, or extra-professional ideologies on my clients and patients or on fellow health professionals and employees. And I agree to maintain proper professional framework and boundaries. When offering on-site or home visits, I agree to administer such MT sessions in a professional manner and refrain from hype and commercial massage. As member of professional association(s) which I may belong to, I also agree to support the professional MT agenda over the commercial massage agenda. Finally, I agree that it is not ethical to call myself a professional when I actually offer commercial services. Among others, therefore, I will not mislead the public to believe that I am a professionally licensed MT, just because I have a license to operate a commercial massage business.

I warrant that the details submitted are true and correct and that future additions or alterations to those details will be true and correct.

[ ] Enclosed are copies of my MT credentials.

Signature:_______________________________ Date:________________