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Massage Intake Form Template

Streamline patient intake for your massage practice

Managing a busy massage practice can be overwhelming, especially when patients arrive without filling out necessary information. This massage intake form template helps you gather essential details from your clients, ensuring a smoother appointment experience and thorough understanding of their needs. Capture medical history, allergies, and specific treatment areas while enjoying simple customization, instant responses, and accessibility across all devices-all without any coding required. Start optimizing your patient intake process today.

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Full name
Date of birth
Email address
Mobile phone number
Preferred contact method
Email
Text message
Phone call
No preference
Parent/Guardian full name (if client is a minor)
Are you completing this form for a minor?
Yes
No
Emergency contact full name
Emergency contact phone number
Relationship to you
Spouse/Partner
Parent/Guardian
Child
Sibling
Friend
Colleague
Other
Please Specify:
Current medications or supplements
Allergies or sensitivities (e.g., medications, nuts, latex, fragrances)
Please indicate any current or past conditions
Please Specify:
Are you currently experiencing any of the following symptoms?
Fever or chills
Cough
Sore throat
Shortness of breath
Nausea or vomiting
Diarrhea
Loss of taste or smell
None of the above
What are your goals for today's session?
Please Specify:
Areas you would like addressed
Please Specify:
Areas to avoid
Please Specify:
Describe any current discomfort, pain, or restrictions (include location, onset, and aggravating factors if known)
Preferred pressure
Very light
Light
Medium
Firm
Very firm
It depends / variable
Therapist gender preference
No preference
Woman therapist
Man therapist
Non-binary therapist
Prefer not to say
Have you received professional massage therapy before?
Yes
No
Have you experienced any adverse reactions to massage?
No
Soreness lasting more than 48 hours
Bruising
Dizziness or nausea
Skin irritation
Other
Please Specify:
Any positions that are uncomfortable for you?
Face down (prone)
Face up (supine)
Side-lying
Sitting
None of the above
I understand massage therapy is not a substitute for medical care and no diagnosis will be made.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I will inform the therapist of any changes to my health before each session.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I understand professional draping will be used and only areas being worked will be undraped.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I acknowledge the cancellation and no-show policy.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Client signature (type full name)
Signature date
Do you consent to receive massage therapy today?
Yes
No
How did you hear about us?
Please Specify:
May we contact you with appointment reminders and important updates?
Yes
No
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Paper art illustration depicting a massage intake form template for FormCreatorAI article

When to use this form

Use this form before every appointment to screen for risks, tailor pressure, and note goals. It works for day spas, solo practitioners, mobile therapists, and school clinics. For clients rehabbing after accidents or falls, pair it with the Personal injury intake form to align with treatment plans. For chair massage days or on-site events, collect basic details with the Intake form for group sessions new client form. At follow-ups, log changes in pain, range of motion, and product reactions with the Session check-in form. The result is clear notes, safer care, and better outcomes you can measure.

Must Ask Massage Intake Questions

  1. Which areas of your body should we focus on or avoid?

    This directs your plan so you spend time where it matters and skip sensitive spots. It also prevents aggravating injuries, numbness, or ticklish areas.

  2. Do you have any current injuries, medical conditions, or recent surgeries?

    This informs pressure, positioning, and modality choices. It flags contraindications such as blood clots, fever, or skin infections that require postponing or adapting care.

  3. What medications, allergies, or skin sensitivities do you have?

    It helps you avoid reactions to oils, lotions, or heat/cold therapies. You can adjust techniques for blood thinners, steroids, or nerve pain meds.

  4. How are your stress levels, sleep, and mood lately?

    Understanding mental and emotional load lets you tune pace, music, and communication style. If a client also sees a therapist, align goals with the Counseling intake form.

  5. What are your goals for today, and how will you measure success?

    Clear goals set expectations and define when to stop or switch techniques. You can document outcomes like less headache pain, better sleep tonight, or more shoulder reach.

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