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Massage Therapy Consent Form Template

Ensure Ethical Practices with Our Easy-to-Use Consent Template

Before your massage therapy sessions, it's essential to ensure that clients fully understand and agree to the treatment they will receive. This Massage Therapy Consent Form Template is designed for therapists who want to establish trust and clarity with their clients, ensuring they are informed and protected. By using this template, you can streamline your consent process, provide clear guidelines for clients, and maintain a professional, ethical practice, all while keeping your forms WCAG-aligned for accessibility. Explore the features of this template to enhance your client experience today.

Full name
Date of birth
Email address
Mobile phone
Emergency contact full name
Emergency contact phone
Are you currently under medical care?
Yes
No
Relevant medical conditions, surgeries, or injuries
Allergies or sensitivities (including oils, lotions, scents)
Current medications or supplements
Pregnancy status
Not pregnant/Not applicable
First trimester
Second trimester
Third trimester
Prefer not to say
Areas of pain, tension, or concern
Do you currently have any of the following? (Select all that apply)
Please Specify:
Have you received professional massage before?
Yes
No
Preferred pressure
Very light
Light
Moderate
Firm
Very firm
No preference
Areas you would like the therapist to avoid (select all that apply)
Please Specify:
Comfort considerations (select all that apply)
Please Specify:
Do you consent to the use of lotion or oil during the session?
Yes
No
I understand that massage therapy is for relaxation and relief of muscular tension and is not a substitute for medical diagnosis or treatment.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will inform the therapist immediately if I experience pain, discomfort, dizziness, or changes to my health.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand that massage therapy involves professional, non-sexual touch and that draping will be used for my privacy.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I have reviewed and accept the cancellation and lateness policy.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I consent to receive massage therapy today.
Yes
No
Signature (type your full legal name)
Signature date
Parent or guardian full name (if client is under 18)
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Paper art illustration depicting a massage therapy consent form template for an article on FormCreatorAI

When to use this form

Use this consent form before any massage session, especially with new clients, clients returning after an injury or surgery, or anyone who is pregnant or under medical care. It helps you screen for contraindications, set pressure and area preferences, and document clear permission to treat. Mobile therapists can send it ahead of time to reduce intake time onsite. Spas can attach it to bookings for sports, prenatal, or deep tissue sessions to keep records compliant. If you offer other services, pair it with the Beauty salon client intake form or the Skin care consultation form to maintain a consistent, client-safe workflow.

Must Ask Massage Therapy Consent Questions

  1. Do you have any current medical conditions, injuries, or areas of pain we should know about?

    This guides your treatment plan, helps you avoid aggravating issues, and supports safe pressure and techniques. Clear details improve outcomes and protect you and the client with documented clinical reasoning.

  2. Are you currently pregnant, recently postpartum, or under the care of a physician for any condition?

    Pregnancy and active medical care can change what techniques are safe and which positions to avoid. Knowing this ensures appropriate modifications or referral when needed.

  3. Do you have any allergies or sensitivities (oils, lotions, latex, scents, heat, or cold)?

    Product and modality sensitivities affect what you can safely use on the skin and in the room. This prevents reactions and builds trust by honoring comfort and safety.

  4. What pressure level do you prefer, and which areas should we focus on or avoid?

    Preference and boundary questions reduce discomfort and clarify draping and off-limits zones. They also help set measurable goals for the session so you can track progress.

  5. Do you understand the potential benefits and risks of massage and consent to treatment today?

    This is the core of informed consent, confirming the client reviewed risks, alternatives, and the right to stop at any time. If you provide multiple services, keep language aligned with your Hair salon waiver form for consistent policies and recordkeeping.

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