Shiatsu in Belgium
1. Legal Status
Shiatsu is not regulated as a distinct healthcare profession under Belgian law. There is no legally protected professional title, no state examination and no government licence specifically required to practise Shiatsu. Practitioners working independently must comply with the general legal and fiscal requirements applicable to self-employed professionals in Belgium.
Although Shiatsu itself is not a regulated healthcare profession, the Belgian Shiatsu Federation (BSF) is an officially recognised professional association, recognised by the Belgian federal authorities responsible for SMEs and self-employed professions.
Since 2025, Shiatsu has its own specific economic activity code within the Belgian NACE-BEL classification:
- NACE-BEL 86.997 – Activities of Shiatsu, Thai Massage, Watsu and Qigong Tuina.
Although this classification does not constitute legal recognition of Shiatsu as a healthcare profession, it officially recognises Shiatsu as a distinct economic activity within the Belgian statistical and administrative system.
From a tax perspective, Shiatsu is treated as an economic activity. Shiatsu services are therefore generally subject to the standard Belgian VAT rate of 21%, unless the practitioner qualifies for a general VAT exemption under Belgian tax legislation.
2. Professional Organisation
The Belgian Shiatsu Federation (BSF), founded in 1990, is the national professional association for Shiatsu in Belgium.
The federation promotes professional standards through the recognition of schools, certification of practitioners, ethical standards, continuing professional development and the maintenance of a public register of certified practitioners.
The BSF maintains an online public register of certified practitioners who meet the federation's professional standards, allowing members of the public to identify qualified practitioners.
The BSF currently (2026) has approximately 270 members and recognises 21 schools.
Fifteen schools provide training in human Shiatsu. The remaining recognised schools also or exclusively teach equine and/or canine Shiatsu.
The recognised curriculum is defined and maintained by the Belgian Shiatsu Federation.
3. Education
The recognised BSF curriculum consists of three training cycles and normally takes four to five years to complete.
The minimum requirements include:
- 450 contact hours, including 50 hours of supervised clinical practice;
- 150 documented treatment reports;
- two in-depth case studies;
- theoretical and practical examinations;
- 60 hours of compulsory education in anatomy, physiology and pathology (20 hours
each).
After certification, practitioners must complete at least 12 hours of Continuing Professional Development (CPD) each year.
4. Certification Levels and Professional Standards
The BSF recognises two professional certification levels.
- C1 & C2 – Shiatsu Wellness Practitioner
Practitioners who have successfully completed the first or second training cycle are credited as Shiatsu Wellness Practitioner. - C3 – Advanced Shiatsu Practitioner
Practitioners who have successfully completed the third training cycle and fulfilled all requirements of the BSF curriculum are credited as Advanced Shiatsu Practitioner.
Practitioners holding either certification level may become members of the BSF.
To be included in the BSF public register, practitioners must additionally comply with the federation's professional requirements, including:
- annual BSF membership;
- a valid Belgian enterprise registration number;
- professional liability insurance;
- adherence to the BSF Code of Ethics;
- adherence to the BSF Complaints Procedure;
- compliance with the applicable annual CPD requirements.
Membership of the BSF is voluntary. However, only practitioners who meet the federation's requirements may be included in the BSF public register.
5. Reimbursement
Shiatsu sessions are partially reimbursed by a limited number of Belgian health insurance funds as an additional benefit for their members. The reimbursement schemes, eligibility criteria and reimbursement amounts vary between health insurance funds.
6. Current Developments
The Belgian Shiatsu Federation is currently in discussion with several Belgian health insurance funds to expand the availability of reimbursement for Shiatsu sessions.