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Massage Therapy Client Intake Form Template

Streamline Your Massage Therapy Practice with This Essential Intake Form

Gathering key information from clients is crucial for providing effective massage therapy. This massage therapy client intake form template helps you collect essential details, ensuring you meet your clients' needs from the start. Easily capture medical history, specific concerns, and preferences with a user-friendly design that enhances your intake process, boosts client satisfaction, and saves time during consultations. Plus, our template is WCAG-aligned for accessibility. Start using the live template to simplify your intake today.

Use this Template (FREE) Live Preview
Full name
Date of birth
Email address
Mobile phone number
Gender
Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
If you selected Prefer to self-describe, please specify (optional)
Emergency contact full name
Emergency contact phone
Emergency contact relationship
Spouse/Partner
Parent/Guardian
Sibling
Friend
Child
Other
Please Specify:
Preferred contact method
Email
Phone call
Text message
Any
How did you hear about us?
Friend/Family
Healthcare provider
Online search
Social media
Event
Walk-by/Signage
Other
Please Specify:
Allergies (select all that apply)
None
Medications
Latex
Nuts
Fragrances/Scents
Adhesives
Essential oils
Other
Please Specify:
If Other allergies, please specify (optional)
Current medications (names only; optional)
Please indicate any current or past conditions (select all that apply)
Please Specify:
Provide details or context about any conditions (optional)
Are you currently pregnant?
Yes
No
Not applicable
Prefer not to say
Any recent injuries, surgeries, or acute conditions in the last 12 months?
Yes
No
If yes, please describe and include dates (optional)
Has a healthcare provider advised you to avoid or modify massage?
Yes
No
Are you experiencing any of the following today? (select all that apply)
Fever
Contagious illness
Open cuts or sores
Sunburn
Severe pain
Bruising
Rash or skin irritation
None of the above
Primary goals for today's session (select all that apply)
Pain relief
Relaxation and stress reduction
Increase range of motion
Improve posture
Sports or event recovery
Headache relief
Prenatal support
General wellness
Other
Please Specify:
Areas of discomfort or focus (select all that apply)
Please Specify:
How severe is your discomfort today?
None
Mild
Moderate
Severe
Not sure
Areas to avoid (select all that apply)
Please Specify:
Preferred overall pressure
Very light
Light
Medium
Firm
Very firm
No preference
Sensitivity to scents or aromatherapy
Yes
No
Unsure
Permission to send appointment reminders and updates
Yes
No
I acknowledge the cancellation and late arrival policy
Yes
No
Informed consent to receive massage therapy today
Yes
No
Type your full name to sign
Signature date
Consent to professional draping for privacy and safety
Yes
No
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Paper art illustration depicting a massage therapy client intake form with relevant sections and design elements

When to use this form

Use this template when you onboard new massage clients, collect updates before a follow-up, or screen walk-ins with health concerns. It helps you capture contact details, emergency info, medical history, medications, allergies, recent injuries, and areas to focus on or avoid. Spa managers, solo therapists, and clinic front desks all benefit: you reduce intake time, flag contraindications, and tailor pressure and techniques. It also supports mobile sessions and prepaid packages by keeping records consistent across visits. If you also intake for other services, reuse fields from the Client intake form. Multidisciplinary clinics can align bodywork with rehab using the Physical therapy intake form.

Must Ask Massage Therapy Client Intake Questions

  1. What are your goals for today and which areas need attention?

    This sets clear expectations and helps you prioritize the session plan. You can focus work where it matters most and avoid aggravating acute issues.

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

    These details protect client safety by revealing contraindications such as blood clots, fractures, or pregnancy. You can adjust techniques, positioning, or duration to fit their needs.

  3. What medications, allergies, or skin sensitivities should we consider?

    Some drugs thin blood or affect pain signals, and allergies guide oil and lotion choices. Knowing this prevents reactions and reduces bruising or dizziness.

  4. What pressure do you prefer, and are there any areas to avoid?

    Preference and boundaries reduce discomfort and ensure consent throughout the session. You will calibrate pressure, draping, and communication to keep the client at ease.

  5. Do you consent to treatment today and agree to our policies?

    Documented consent and clear policies build trust and reduce disputes about scope, privacy, and cancellations. You can align terms with your wider intake, like the Legal client intake form.

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