Reflexology Treatment Plan (Course of Care)

Reflexology Treatment Plan (Course of Care)

Client Name: [Client full name]

Date of Birth: [DOB]

Preferred Name/Pronouns: [Preferred name and pronouns] (Only include if provided)

Plan Date: [Date plan created]

Plan Status: [Draft / Active / On Hold / Completed / Discontinued]

Practitioner Name & Credentials: [Practitioner name, credentials]

Practice/Clinic: [Practice or clinic name]

Referring Clinician: [Name and contact] (Only include if applicable)

Authorization to Communicate with External Clinicians: [Yes / No]

Permitted Recipients: [Names/roles and contact information] (Only include if authorization is Yes)

Service Scope & Informed Consent

Scope Statement: Reflexology is a supportive, client-centered service that applies comfortable pressure to specific points on the feet, hands, or ears to promote relaxation and wellbeing. It is not a substitute for medical care and is not diagnostic or prescriptive. Clients are encouraged to consult their healthcare providers for medical concerns.

Consent Date: [Consent date]

Topics Discussed: Nature and purpose of the session series; expected reassessment cadence; common transient responses (soreness, sensitivity, fatigue, emotional release); alternatives including no treatment or medical evaluation; right to stop or modify at any time

Client Decision: [Agrees / Declines / Defers]

(If consent cannot be obtained, set Plan Status to Draft and note "Consent pending—no treatment under this plan.")

Client Preferences & Boundaries

Pressure Tolerance: [light / moderate / firm] [Additional notes on tolerance]

Areas to Avoid or Modify: [Areas to avoid or modifications requested]

Positioning Limitations: [Preferred positions and limitations]

Other Considerations: [Cultural, religious, or accessibility needs] (Only include if provided)

Presenting Concerns & Client Goals

Primary Concern (client quote): "[Client's primary reason for seeking reflexology in their own words]"

Practitioner Summary: [Brief neutral summary of presenting concerns without medical diagnosis]

Client-Stated Goals: [Goals in client's own language, e.g., "sleep better," "reduce foot tension," "feel less stressed"]

Relevant Context: [Impacts on sleep, mood, activity, work tolerance; onset/pattern; scheduling or frequency constraints] (Only include if mentioned)

Client-Reported or Referred Diagnosis: [Diagnosis as stated] (Label as "client-reported" or "per referring clinician"; only include if provided; do not infer diagnoses)

Health History & Safety Screening

Relevant Medical History: [Items relevant to safe touch-based care and plan modifications]

Medications/Supplements: [Especially those affecting bruising, bleeding, sensation, or skin integrity]

Allergies/Sensitivities: [Lotions, creams, latex, fragrances]

Skin Integrity at Intended Sites: [intact / concerns noted] [Specify location if concerns noted]

Altered Sensation/Neuropathy: [present / absent / unknown]

Circulatory Concerns: [Client-reported details; note if medical clearance requested]

Pregnancy/Postpartum: [Status and relevant details] (Only include if relevant)

Recent Surgery/Procedures Affecting Feet/Hands/Ears: [Details] (Only include if applicable)

Screening Action: [proceed / modify approach / defer / request clearance / refer]

(If health history is incomplete, note "Incomplete—risk screen pending" and indicate plan will proceed with conservative tolerance assessment only. Do not state "screen negative" without active screening.)

Baseline Findings & Outcome Measures

Skin Condition: [intact / not intact] [Specify laterality and locations]

Edema: [present / absent] [Location if present]

Areas of Tenderness/Sensitivity: [Client-reported areas during assessment]

Asymmetry Notes: [Observations relevant to tolerability] (Only include if relevant)

Baseline Client-Reported Measures: [Measure name and baseline value for each, e.g., stress rating 0–10, sleep quality, pain intensity, fatigue level]

Standardized Instrument: [Instrument name] — [Administration method] — [Baseline score] (Only include if used)

(If baseline measures not captured at plan creation, note "Baseline to be obtained at Visit 1" and list which measures will be collected.)

Course of Care Plan

Frequency: [e.g., 1×/week, 2×/month]

Duration: [e.g., 6 weeks, 8 visits]

Session Length: [e.g., 45 minutes hands-on + 10 minutes check-in/out]

Focus Areas: [feet / hands / ears; combined or alternating; laterality emphasis if applicable]

Approach: [Comfort/tolerance parameters and modifications for precautions]

(If frequency or duration not yet determined, set Plan Status to Draft and document decision point.)

Between-Visit Recommendations (education): [Educational suggestions such as hydration, relaxation practice, symptom logging] (Only include if provided; label as education rather than prescription)

Goals

(Document measurable goals using SMART structure. Use symptom, function, or well-being language—do not claim cure or treatment of a named disease. Add or remove goals as appropriate.)

• Goal Statement: [What will change]

  Baseline: [Current value or status]

  Target: [Measurable endpoint]

  Timeframe: [By date or visit number]

  Measure/Source: [client report / rating scale / standardized questionnaire]

(If measurable target not yet agreed, note "Goal to be finalized after baseline measures at Visit 1.")

Reassessment Schedule

Reassessment Interval: [e.g., every 4 visits or every 4–6 weeks]

What Will Be Reassessed: [Outcome measures, tolerance, progress toward goals, client priorities]

Decision Rules:

• If improving as expected: continue or consider tapering frequency
• If plateau: modify approach, revise goals, or consider referral
• If worsening or new concerns: stop or hold sessions and refer for medical evaluation

Referral & Stop Criteria

Immediate Stop and Medical Referral Triggers: New or worsening symptoms suggesting need for medical evaluation; skin integrity concerns making touch inappropriate; unexpected severe pain response or unexplained swelling; client requests medical evaluation or expresses concerning symptoms

Non-Urgent Referral Triggers: Persistent lack of progress despite plan modifications; client requests coordination with a clinician

Referral Recommendation: [Recommendation details, clinician type, and whether client accepted or declined] (Only include if referral recommended)

Plan Attestation

Practitioner Attestation: I, [Practitioner name and credentials], attest that this plan reflects the discussed approach and client preferences within the scope of reflexology practice.

Practitioner Signature: [Signature or electronic attestation]

Date: [Date]

Client Acknowledgment: [Signed / documented verbal acknowledgment] — [Date]

Plan Amendments

[Amendment date]: [Summary of change] — [Reason] — Client informed: [Yes / No]

(If no amendments, note "No amendments to date." For each amendment after initial creation, document date, what changed, why, and whether client was informed.)