10

Technology and
Livelihood Education
Wellness Massage
Quarter 1 – Module 4:
Relevant Information of the Client
T.L.E. – Wellness Massage – Grade 10
Self-Learning Module (SLM)
Quarter 1 – Module 4: Relevant Information of the Client
First Edition, 2020

Republic Act 8293, section 176 states that: No copyright shall subsist in any work
of the Government of the Philippines. However, prior approval of the government agency or
office wherein the work is created shall be necessary for exploitation of such work for profit.
Such agency or office may, among other things, impose as a condition the payment of
royalties.

Borrowed materials (i.e., songs, stories, poems, pictures, photos, brand names,
trademarks, etc.) included in this module are owned by their respective copyright holders.
Every effort has been exerted to locate and seek permission to use these materials from
their respective copyright owners. The publisher and authors do not represent nor claim
ownership over them.

Development Team of the Module

Writers: Khaleda T. Wamar
Editors: Christine Charity A. Geonzon
Reviewers: Reynaldo M. Pascua, CESE
Illustrator: Khaleda T. Wamar
Layout Artist: Reynante A. Naral
Cover Art Designer: Reggie D. Galindez
Management Team: Allan G. Farnazo, CESO IV – Regional Director
Fiel Y. Almendra, CESO V – Assistant Regional Director
Omar A. Obas, CESO V - Schools Division Superintendent
Jasmin P. Isla - Assistant Schools Division Superintendent
Gilbert B. Barrera – Chief, CLMD
Arturo D. Tingson Jr. – REPS, LRMS
Peter Van C. Ang-ug – REPS, ADM
Gilda O. Orendain – Subject Area Supervisor
Dr. Meilrose B. Peralta - CID Chief
Hazel G. Aparece-- Division EPS In Charge of LRMS
Antonio R. Pasigado Jr. --Division ADM Coordinator
Reynaldo M. Pascua, CESE - Subject Area Supervisor

Printed in the Philippines by Department of Education – SOCCSKSARGEN Region

Office Address: Regional Center, Brgy. Carpenter Hill, City of Koronadal

Telefax: (083) 2288825/ (083) 2281893
E-mail Address: region12@deped.gov.ph
 10
Technology and
Livelihood
Education

Wellness Massage
Quarter 1 – Module 4:
Relevant Information of the
Client
Introductory Message
To the facilitator:

Welcome to the T.L.E. – Wellness Massage Grade 10 Self-Learning Module

(SLM) on the Relevant Information of the Client!

This module was collaboratively designed, developed and reviewed by

educators both from public and private institutions to assist you, the teacher or
facilitator in helping the learners meet the standards set by the K to 12 Curriculum
while overcoming their personal, social, and economic constraints in schooling.

This learning resource hopes to engage the learners into guided and
independent learning activities at their own pace and time. Furthermore, this also
aims to help learners acquire the needed 21 st century skills while taking into
consideration their needs and circumstances.

In addition to the material in the main text, you will also see this box in the
body of the module:

Notes to the Teacher

This contains helpful tips or strategies
that will help you in guiding the learners.

As a facilitator you are expected to orient the learners on how to use this
module. You also need to keep track of the learners' progress while allowing them
to manage their own learning. Furthermore, you are expected to encourage and
assist the learners as they do the tasks included in the module.

To the learner:

Welcome to the T.L.E. – Wellness Massage Grade 10 Self-Learning Module

(SLM) on the Relevant Information of the Client!

The hand is one of the most symbolized parts of the human body. It is often
used to depict skill, action and purpose. Through our hand we may learn, create
and accomplish. Hence, the hand in this learning resource signifies that you as a
learner is capable and empowered to successfully achieve the relevant
competencies and skills at your own pace and time. Your academic success lies in
your own hands!

This module was designed to provide you with fun and meaningful
opportunities for guided and independent learning at your own pace and time. You
will be enabled to process the contents of the learning resource while being an
active learner.

This module has the following parts and corresponding icons:

What I Need to Know This will give you an idea of the skills or
competencies you are expected to learn in
the module.

What I Know This part includes an activity that aims to

check what you already know about the
lesson to take. If you get all the answers
correct (100%), you may decide to skip this
module.

What’s In This is a brief drill or review to help you link

the current lesson with the previous one.

What’s New In this portion, the new lesson will be

introduced to you in various ways such as a
story, a song, a poem, a problem opener, an
activity or a situation.

What is It This section provides a brief discussion of

the lesson. This aims to help you discover
and understand new concepts and skills.

What’s More This comprises activities for independent

practice to solidify your understanding and
skills of the topic. You may check the
answers to the exercises using the Answer
Key at the end of the module.

What I Have Learned This includes questions or blank

sentences/paragraphs to be filled in to
process what you learned from the lesson.

What I Can Do This section provides an activity which will

help you transfer your new knowledge or
skill into real life situations or concerns.

Assessment This is a task which aims to evaluate your

level of mastery in achieving the learning
competency.

Additional Activities In this portion, another activity will be given

to you to enrich your knowledge or skill of
the lesson learned. This also tends retention
of learned concepts.

Answer Key This contains answers to all activities in the

module.
At the end of this module you will also find:

References This is a list of all sources used in

developing this module.
The following are some reminders in using this module:

1. Use the module with care. Do not put unnecessary mark/s on any part of
the module. Use a separate sheet of paper in answering the exercises.
2. Don’t forget to answer What I Know before moving on to the other activities
included in the module.
3. Read the instructions carefully before doing each task.
4. Observe honesty and integrity in doing the tasks and checking your
answers.
5. Finish the task at hand before proceeding to the next.
6. Return this module to your teacher/facilitator once you are through with it.
If you encounter any difficulty in answering the tasks in this module, do not
hesitate to consult your teacher or facilitator. Always bear in mind that you are
not alone.

We hope that through this material, you will experience meaningful learning
and gain deep understanding of the relevant competencies. You can do it!

What I Need to Know

Massage must always be given to bring about improvement, either of specific

conditions, or the general well-being of each client. Clients should always feel that
the treatment is beneficial and helping them to achieve their desired results.
Massage should never be given if there is any risk of harming the client or making
any condition worse. In this module, you will learn to identify the health history of
the client as well as the contra-indications with some important terms.
This module is aimed for you to:

1. Identify the relevant information of the clients in terms of health history and
contra-indications;
2. Discuss the following relevant terms:
a. Inter/Intra-personal relationship
b. Information gathering; and
c. Standard Operating Procedures (SOP); and
3. Conduct self-assessment in terms of personal information and medical
history.
 What I Know

Pre-test
Directions: State the meaning of the following terms in your own words. Write your
answers on the boxes provided on their right side.

Health History

Contra-indications

Inter-personal relationship

Intra-personal relationship

Standard Operating Procedures (SOP)

Lesson
Relevant Information of the
4 Client

What’s In

Activity 1: What are the Questions?

Directions: In the previous lesson, you have learned that in screening your ideas,
you need to examine each one in terms of guide questions. Write at least five (5) of
these guide questions.

1. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
3. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
4. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
5. _____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
 What’s New

Activity 1: Self-assessment
Directions: Knowing your body and health condition would be a great help for a
massage therapist to know what kind of treatment he/she will apply to
you. Below are the lists of health conditions. Put a check in the
column on the health conditions that you have.

Conditions Yes No

Cardio-vascular problem

Allergic reactions

Fragile skin

Under healing process

A pin or plate is inserted in your bone

Activity 2: Show a Situation

Directions: Give example of situation that the following terms are being discussed.
Write your answer on the blanks provided.
Inter-personal relationship –
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Intra-personal relationship –
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Standard Operating Procedures (SOP) –

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
 What is It

Activity 3: Reflection
Directions: Answer the following questions and write your answers at the spaces
provided.

1. How were you able to assess yourself on the contra-indications that you may
have?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

2. How were you able to give example of situations that the three terms (inter-
personal, intra-personal, and standard operating procedures (SOP) are being
discussed?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Understanding contra-indications
Contra-indications are conditions in which massage should not be applied
because it may harm the client. Massage must always be given to bring about
improvement, either of specific conditions, or the general well-being of each client.
Clients should always feel that the treatment is beneficial and helping them to
achieve their desired results. Massage should never be given if there is any risk of
harming the client or making any condition worse. The effects of massage may be
harmful in certain circumstances. The following explanations will help you to
understand why massage should not be carried out if certain conditions are
present. There are dangers associated with the following contra-indications:

1. Cardio-vascular problems
Massage is thought to increase blood flow, which is desirable in many
conditions but can be dangerous in others.
 2. Lymphatic drainage
The lymphatic system removes excess fluid from all over the body, returning it
into the bloodstream. Because massage increases lymphatic flow, the rate in which
these toxic substances are carried and spread around the body is increased. Be
particularly aware if the client has swollen or painful lymph glands; do not
massage, and seek medical advice.

3. Skin contact and friction

As the hands move over the client‘s skin, any bacterial, viral or fungal infections
can be spread over the skin to a non-infected area or onto the therapist‘s hands.
Infections may be transmitted from client to therapist or from therapist to client in
this way.

4. The healing process

Any injury or damage to the tissues or fractures of bones must be allowed to
heal completely before massage is given to the area. If massage is given before
healing is complete, there is a danger of further damage to the tissues and delaying
the healing process.

5. Pins and plates

If massage is performed over an area where pins and plates have been inserted
to stabilize bones and joints, there is a danger of their becoming loose, and also,
through the pressure of massage over any protruding parts, there is a danger of
damaging the surrounding soft tissues.

6. Allergic reactions
The oil or cream etc. used as the massage medium may cause an allergic
reaction in some clients. This will produce an excessive erythema: the area
becoming very red and hot or a rash may appear. Remove the medium immediately
and wash in warm water.

7. Fragile skin
There is always a danger of breaking down fragile, thin skin, causing open
wounds. Particular care must be taken with diabetics and anyone on steroid
treatments as the skin may be fragile and healing may be slow. Plenty of
lubrication and light pressure only must be used.
 8. Infections
It is common sense to avoid touching anything infectious such as athlete‘s foot,
eczema and also to treat someone if they have a contagious disease such as
chicken fox.

9. Inflammation
Deep massage worsens any type of inflammation, whether an inflamed injury,
irritable bowels, or an inflamed arthritic joint. Indications of inflammation include
heat, pain or discomfort, swelling, and redness. Light, gentle stroking, however,
may offer some relief and comfort. Threat undiagnosed inflammation under the
skin (any unusual lump or bump) with caution, it may indicate a cyst that might
burst or, more worryingly, a cancerous growth.

10. Cancer
One school of thought postulates that massage can spread cancer through the
lymphatic system. While this remains unproven and there is much evidence to
dispute the theory, it is a good idea to obtain permission from a doctor before
massaging people with cancer.

11. Pregnancy and Full Stomach

During the first three months of pregnancy, do not massage with any pressure
on the abdomen and lower back, this is the most common time period for
miscarriage, and massage can stimulate contractions. During the two or three days
of menstruation, massage on the abdomen and lower back may make bleeding
heavier, check your partners preference before giving a massage. Avoid massaging
if someone has just eaten, as the massage could make them feel nauseated.

How to create Inter/Intra Personal Relationship

Inter-personal relationship is an association or acquaintance between two or

more people while intra-personal relationship is the relationship you have with
yourself.

Information Gathering is important for the following reasons to establish

inter/intra personal relationship:

 To establish a rapport with the client and put her/him at ease.

 To develop mutual trust and gain the client‘s confidence.
 To gain information on the client‘s past and present state of mental and
physical health.
 To identify the client‘s needs and expectations of the treatment.
  To establish the most appropriate form of treatment and to discuss and
agree this with the client.
 To explain the treatment fully to the client, including the procedure,
expected effects.
 To answer queries and questions related to the treatment and to allay
doubts and fears.

Standard Operating Procedures (SOP)

Standard operating procedures are written, step-by-step instructions that

describe how to perform a routine activity. Employees should complete them in the
exact same way every time so that the business can remain consistent. Standard
operating procedures help maintain safety and efficiency for departments such as:

 Production/operations
 Sales and customer service
 Employee training
 Legal
 Financial

A standard operating procedure should never be difficult to read or vaguely

worded. It should be brief, easy to understand and contain actions steps that are
simple follow. A good standard operating procedure should clearly outline the steps
and inform the employee of any safety concerns.
 What’s More

Activity 4: Client Intake Form

Directions: Examine the Client Intake Form on the next page. Answer the
questions that follow and do the special task given.

Client Intake Form – Therapeutic Massage

Personal Information
Name: _____________________________ Phone (Day): ________ Phone (Eve): ________
Address: _____________________________________________________________________
City/State/Zip: _______________________________________________________________
E-mail: ____________________ Date of Birth: ____________ Occupation: ___________
Emergency Contact: ______________________________ Phone: ____________________

The following information will be used to help plan safe and effective massage
sessions. Please answer the questions to the best of your knowledge.
Date of initial visit: ___________________________________________________________
1. Have you had a professional massage before? Yes No
If yes, how often do you receive massage therapy? _______________________
2. Do you have any difficulty lying on your front, back or side? Yes No
If yes, please explain ___________________________________________________
3. Do you have any allergies to oils, lotions, or ointments? Yes No
If yes, please explain ___________________________________________________
4. Do you have sensitive skin? Yes No
5. Are you wearing contact lenses ( ) dentures ( ) a hearing aid ( )?
6. Do you sit for long hours at a workstation, computer or driving? Yes No
If yes, please describe __________________________________________________
7. Do you perform any repetitive movement in your work, sports, or hobby?
Yes No
If yes, please describe __________________________________________________
8. Do you experience stress in your work, family, or other aspect of your
life? Yes No
9. Is there a particular area of the body where you are experiencing tension,
stiffness, pain or other discomfort? Yes No
If yes, please identify ___________________________________________________
10.Do you have any particular goals in mind for this massage session?
Yes No
If yes, please explain ___________________________________________________

Circle any specific areas you would

like the massage therapist to
concentrate on during
the session.
Medical History
In order to plan a massage session that is safe and effective,
I need some general information about your medical history.
11. Are you currently under medical supervision? Yes No
If yes, please explain ___________________________________________________
12. Do you see a chiropractor? If yes, how often?
13. Are you currently taking any medication? Yes No
If yes, please list _______________________________________________________
14. Please check any condition listed below that applies to you:
( ) contagious skin condition ( ) phlebitis
( ) open sores or wounds ( ) deep vein thrombosis/blood clots
( ) easy bruising ( ) joint disorder/rheumatoid arthritis/osteoarthritis/tendonitis
( ) recent accident/injury ( ) osteoporosis
( ) recent fracture ( ) epilepsy
( ) recent surgery ( ) headaches/migraines
( ) artificial joint ( ) cancer
( ) sprains/strains ( ) diabetes
( ) current fever ( ) decreased sensation
( ) swollen glands ( ) back/neck problems
( ) allergies/sensitivity ( ) Fibromyalgia
( ) heart condition ( ) TMJ
( ) high or low blood pressure ( ) carpal tunnel syndrome
( ) circulatory disorder ( ) tennis elbow
( ) varicose veins ( ) pregnancy If yes, how many months?
( ) atherosclerosis

Please explain any condition that you have marked above

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
15. Is there anything else about your health history that you think would be
useful for your massage practitioner to know to plan a safe and effective
massage session for you?
______________________________________________________________________________
______________________________________________________________________________
Draping will be used during the session – only the area being worked on will be uncovered.
Clients under the age of 17 must be accompanied by a parent or legal guardian during the entire
session. Informed written consent must be provided by parent or legal guardian for any client
under the age of 17.

I, ________________________ understand that the massage I receive is provided for

the basic purpose of relaxation and relief of muscular tension. If I experience any pain or
discomfort during this session, I will immediately inform the therapist so that the pressure
and/or strokes may be adjusted to my level of comfort. I further understand that massage
should not be construed as a substitute for medical examination, diagnosis, or treatment
and that I should see a physician, chiropractor or other qualified medical specialist for any
mental or physical ailment that I am aware of. I understand that massage therapists are
not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any
physical or mental illness, and that nothing said in the course of the session given should
be construed as such. Because massage should not be performed under certain medical
conditions, I affirm that I have stated all my known medical conditions, and answered all
questions honestly. I agree to keep the therapist updated as to any changes in my medical
profile and understand that there shall be no liability on the therapist’s part should I fail to
do so.

Signature of client: _______________________________________________ Date: _______________________

Signature of Massage Therapist: __________________________________ Date: _______________________

Questions:

1. Why is medical history needed in the information gathering prior to a

massage session?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

2. What will you do if your client has checked any of the conditions in item
number 14 of the Client Intake Form?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

3. What is the purpose of requiring the client’s signature at the last part of the
form?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

Special Task:

Directions: For you to be able to be familiar with the conditions stated in the
Client Intake Form, conduct a ‘Dictionary Visit’ and look for their definitions. Write
it on the boxes provided at its opposite.

1. bruising

2. fracture

3. surgery

4. artificial joint

5. sprains/strains

6. allergies/sensitivity
7. heart condition

8. high or low blood pressure

9. circulatory disorder

10. varicose veins

11. atherosclerosis

12. phlebitis

13. deep vein thrombosis

14. rheumatoid arthritis

15. osteoarthritis

16. tendonitis

17. osteoporosis

18. epilepsy

19. migraines

20. cancer
 21. diabetes

22. decreased sensation

23. Fibromyalgia

24. TMJ

25. carpal tunnel syndrome

26. tennis elbow

What I Have Learned

Activity 5: Sum it Up!

Directions: As a generalization of the lessons learned in this module, complete the
following sentences with your own words:

As massage therapists, gathering information on the health history of

our clients is very important, because ________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_
 As massage therapists, we need to establish inter/intra-personal
relationship with ____________________________________________________, so that
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

In a massage clinic, standard operating procedures (SOP) must be

implemented so that _________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

An information gathering which consists of ____________________________

______________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________
is very vital in a massage service, because ______________________________________

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
 What I Can Do

Activity 6: Information Gathering

Directions: Conduct an information gathering on one of the members of your
family using the Client Intake Form.

Client Intake Form – Therapeutic Massage

Personal Information
Name: _____________________________ Phone (Day): ________ Phone (Eve): ________
Address: _____________________________________________________________________
City/State/Zip: _______________________________________________________________
E-mail: ____________________ Date of Birth: ____________ Occupation: ___________
Emergency Contact: ______________________________ Phone: ____________________

The following information will be used to help plan safe and effective massage
sessions. Please answer the questions to the best of your knowledge.
Date of initial visit: ___________________________________________________________
1. Have you had a professional massage before? Yes No
If yes, how often do you receive massage therapy? _______________________
2. Do you have any difficulty lying on your front, back or side? Yes
No
If yes, please explain ___________________________________________________
3. Do you have any allergies to oils, lotions, or ointments? Yes No
If yes, please explain ___________________________________________________
4. Do you have sensitive skin? Yes No
5. Are you wearing contact lenses ( ) dentures ( ) a hearing aid ( )?
6. Do you sit for long hours at a workstation, computer or driving? Yes No
If yes, please describe __________________________________________________
7. Do you perform any repetitive movement in your work, sports, or hobby?
Yes No
If yes, please describe __________________________________________________
8. Do you experience stress in your work, family, or other aspect of your
life? Yes No
9. Is there a particular area of the body where you are experiencing tension,
stiffness, pain or other discomfort? Yes No
If yes, please identify ___________________________________________________
10.Do you have any particular goals in mind for this massage session?
Yes No
If yes, please explain ___________________________________________________

Circle any specific areas you would

like the massage therapist to
concentrate on during
the session.
Medical History
In order to plan a massage session that is safe and effective,
I need some general information about your medical history.
11. Are you currently under medical supervision? Yes No
If yes, please explain ___________________________________________________
12. Do you see a chiropractor? If yes, how often?
13. Are you currently taking any medication? Yes No
If yes, please list _______________________________________________________
14. Please check any condition listed below that applies to you:
( ) contagious skin condition ( ) phlebitis
( ) open sores or wounds ( ) deep vein thrombosis/blood clots
( ) easy bruising ( ) joint disorder/rheumatoid arthritis/osteoarthritis/tendonitis
( ) recent accident/injury ( ) osteoporosis
( ) recent fracture ( ) epilepsy
( ) recent surgery ( ) headaches/migraines
( ) artificial joint ( ) cancer
( ) sprains/strains ( ) diabetes
( ) current fever ( ) decreased sensation
( ) swollen glands ( ) back/neck problems
( ) allergies/sensitivity ( ) Fibromyalgia
( ) heart condition ( ) TMJ
( ) high or low blood pressure ( ) carpal tunnel syndrome
( ) circulatory disorder ( ) tennis elbow
( ) varicose veins ( ) pregnancy If yes, how many months?
( ) atherosclerosis

Please explain any condition that you have marked above

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
15. Is there anything else about your health history that you think would be
useful for your massage practitioner to know to plan a safe and effective
massage session for you?
______________________________________________________________________________
______________________________________________________________________________
Draping will be used during the session – only the area being worked on will be uncovered.
Clients under the age of 17 must be accompanied by a parent or legal guardian during the entire
session. Informed written consent must be provided by parent or legal guardian for any client
under the age of 17.

I, ________________________ understand that the massage I receive is provided for

the basic purpose of relaxation and relief of muscular tension. If I experience any pain or
discomfort during this session, I will immediately inform the therapist so that the pressure
and/or strokes may be adjusted to my level of comfort. I further understand that massage
should not be construed as a substitute for medical examination, diagnosis, or treatment
and that I should see a physician, chiropractor or other qualified medical specialist for any
mental or physical ailment that I am aware of. I understand that massage therapists are
not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any
physical or mental illness, and that nothing said in the course of the session given should
be construed as such. Because massage should not be performed under certain medical
conditions, I affirm that I have stated all my known medical conditions, and answered all
questions honestly. I agree to keep the therapist updated as to any changes in my medical
profile and understand that there shall be no liability on the therapist’s part should I fail to
do so.

Signature of client: _______________________________________________ Date: _______________________

Signature of Massage Therapist: __________________________________ Date: _______________________

 Assessment

Directions: Inside the boxes are relevant terms. Discuss the following relevant
terms briefly by writing your answers at the space provided.

Contra-indication

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Standard Operating Procedures (OP)

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Inter-personal Relationship

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

Intra-personal Relationship
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
 Assessment Rubric for Written Discussion

EXCELLENT GOOD POOR

Shows a full Shows a good Does not seem to

CONTENT
understanding of understanding of understand the
KNOWLEDGE
the topic. parts of the topic. topic well.

Presents all ideas Presents some of Does not present

ORGANIZATION
in an organized the ideas in an ideas in an
OF IDEAS
way. organized way. organized way.

Sentences are Most sentences

well-constructed, are well- Sentences have
with standard constructed, with significant
GRAMMAR & spelling and standard spelling grammar or
SPELLING grammar (not the and grammar (not spelling errors
kinds of the kinds of and/or non-
abbreviations abbreviations standard English.
used while texting) used while texting)
 Additional Activities

Activity 7: Assess Yourself!

Directions: Conduct an information gathering on yourself using the Client Intake
Form.
Client Intake Form – Therapeutic Massage
Personal Information
Name: _____________________________ Phone (Day): ________ Phone (Eve): ________
Address: _____________________________________________________________________
City/State/Zip: _______________________________________________________________
E-mail: ____________________ Date of Birth: ____________ Occupation: ___________
Emergency Contact: ______________________________ Phone: ____________________

The following information will be used to help plan safe and effective massage
sessions. Please answer the questions to the best of your knowledge.
Date of initial visit: ___________________________________________________________
1. Have you had a professional massage before? Yes No
If yes, how often do you receive massage therapy? _______________________
2. Do you have any difficulty lying on your front, back or side? Yes
No
If yes, please explain ___________________________________________________
3. Do you have any allergies to oils, lotions, or ointments? Yes No
If yes, please explain ___________________________________________________
4. Do you have sensitive skin? Yes No
5. Are you wearing contact lenses ( ) dentures ( ) a hearing aid ( )?
6. Do you sit for long hours at a workstation, computer or driving? Yes No
If yes, please describe __________________________________________________
7. Do you perform any repetitive movement in your work, sports, or hobby?
Yes No
If yes, please describe __________________________________________________
8. Do you experience stress in your work, family, or other aspect of your
life? Yes No
9. Is there a particular area of the body where you are experiencing tension,
stiffness, pain or other discomfort? Yes No
If yes, please identify ___________________________________________________
10.Do you have any particular goals in mind for this massage session?
Yes No
If yes, please explain ___________________________________________________

Circle any specific areas you would

like the massage therapist to
concentrate on during
the session.
Medical History
In order to plan a massage session that is safe and effective,
I need some general information about your medical history.
11. Are you currently under medical supervision? Yes No
If yes, please explain ___________________________________________________
12. Do you see a chiropractor? If yes, how often?
13. Are you currently taking any medication? Yes No
If yes, please list _______________________________________________________
14. Please check any condition listed below that applies to you:
( ) contagious skin condition ( ) phlebitis
( ) open sores or wounds ( ) deep vein thrombosis/blood clots
( ) easy bruising ( ) joint disorder/rheumatoid arthritis/osteoarthritis/tendonitis
( ) recent accident/injury ( ) osteoporosis
( ) recent fracture ( ) epilepsy
( ) recent surgery ( ) headaches/migraines
( ) artificial joint ( ) cancer
( ) sprains/strains ( ) diabetes
( ) current fever ( ) decreased sensation
( ) swollen glands ( ) back/neck problems
( ) allergies/sensitivity ( ) Fibromyalgia
( ) heart condition ( ) TMJ
( ) high or low blood pressure ( ) carpal tunnel syndrome
( ) circulatory disorder ( ) tennis elbow
( ) varicose veins ( ) pregnancy If yes, how many months?
( ) atherosclerosis

Please explain any condition that you have marked above

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
15. Is there anything else about your health history that you think would be
useful for your massage practitioner to know to plan a safe and effective
massage session for you?
______________________________________________________________________________
______________________________________________________________________________
Draping will be used during the session – only the area being worked on will be uncovered.
Clients under the age of 17 must be accompanied by a parent or legal guardian during the entire
session. Informed written consent must be provided by parent or legal guardian for any client
under the age of 17.

I, ________________________ understand that the massage I receive is provided for

the basic purpose of relaxation and relief of muscular tension. If I experience any pain or
discomfort during this session, I will immediately inform the therapist so that the pressure
and/or strokes may be adjusted to my level of comfort. I further understand that massage
should not be construed as a substitute for medical examination, diagnosis, or treatment
and that I should see a physician, chiropractor or other qualified medical specialist for any
mental or physical ailment that I am aware of. I understand that massage therapists are
not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any
physical or mental illness, and that nothing said in the course of the session given should
be construed as such. Because massage should not be performed under certain medical
conditions, I affirm that I have stated all my known medical conditions, and answered all
questions honestly. I agree to keep the therapist updated as to any changes in my medical
profile and understand that there shall be no liability on the therapist’s part should I fail to
do so.

Signature of client: _______________________________________________ Date: _______________________

Signature of Massage Therapist: __________________________________ Date: _______________________

 Answer Key

7. Is the business in line with your interest and expertise?

government regulation?
6. Will the business be legal and not against any existing or foreseeable
particular business?
5. Do you have the background and experiences needed to run this
being met (supply)?
the needs (competition or demand)? How much of the need is now
4. How is the demand met? Who are processing the products to meet
product and will continue to need it for a long time?
3. How big is the demand for the product? Do many people need this
2. Where should the business be located?
1. How much capital is needed to put up the business?
Activity 1: What are the Questions?

Assessment Rubric for Written Discussion

EXCELLENT GOOD POOR

Shows a full Shows a good Does not seem

CONTENT
understanding of understanding of to understand
KNOWLEDGE
the topic. parts of the topic. the topic well.

Does not
Presents all ideas Presents some of
ORGANIZATION present ideas
in an organized the ideas in an
OF IDEAS in an
way. organized way.
organized way.

Most sentences
Sentences are Sentences
are well-
well-constructed, have
constructed, with
with standard significant
standard spelling
GRAMMAR & spelling and grammar or
and grammar
SPELLING grammar (not the spelling errors
(not the kinds of
kinds of and/or non-
abbreviations
abbreviations standard
used while
used while texting) English.
texting)
References

https://www.academia.edu/34705203/Lmwellnessmassageg10_151012103134_lv
a1_app

https://tallyfy.com/standard-operating-procedure-sop/
http://www.willowriverchiropractic.com/storage/app/media/Massage_Intake_For
m_and_Policies_5-25-2016.pdf
 DISCLAIMER
This Self-learning Module (SLM) was developed by DepEd SOCCSKSARGEN
with the primary objective of preparing for and addressing the new normal.
Contents of this module were based on DepEd’s Most Essential Learning
Competencies (MELC). This is a supplementary material to be used by all
learners of Region XII in all public schools beginning SY 2020-2021. The
process of LR development was observed in the production of this module.
This is version 1.0. We highly encourage feedback, comments, and
recommendations.

For inquiries or feedback, please write or call:

Department of Education – SOCCSKSARGEN

Learning Resource Management System (LRMS)

Regional Center, Brgy. Carpenter Hill, City of Koronadal

Telefax No.: (083) 2288825/ (083) 2281893

Email Address: region12@deped.gov.ph