Massage Therapy Invoice Template Details

Listed here, you can find some information regarding invoice template massage therapy PDF. This figure can provide specifics of the form's length, completion duration, and the blanks you may be needed to fill.

QuestionAnswer
Form NameInvoice Template Massage Therapy
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmassage invoice template word, massage therapy receipt, massage therapy invoice, massage therapy invoice samples

Form Preview Example

 

 

Intrinsic Touch Massage Therapy

 

 

 

Client Intake Form

 

 

 

 

 

 

 

 

 

 

 

 

First Name:

 

Last Name:

 

 

 

 

 

 

 

 

 

 

 

 

Phone Number (s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

Birth date or Age:

 

 

Birth Month:

 

 

 

 

 

 

 

 

 

 

 

 

Email Address: (if you would like to be informed about specials)

How did you hear about me? e.g. Internet Search, Gift Certificate, Friend, Flier, Ad, other

If you heard about me from family or a friend, please put their name here:

Occupation (please also include your work duties e.g. sitting at a computer, lifting, telephone, etc.)

Massage Experience (how often / type)

Are there any areas you would like me to avoid (example: face, scalp, feet)

Are you or have you ever been treated for cancer? If so, please describe:

Injury History in the last 5 years(car accidents, broken bones, dislocations, falls, etc.)

Recent Surgeries? If so, when?

Do you have any of the following conditions? (please check the left box for all that apply)

 

Neck Pain

 

High Blood Pressure

 

Fibromyalgia

 

Headaches

 

Back Pain

 

Scoliosis

 

Pregnant or Trying?

 

Diabetes

 

Skin Condition

 

Heart Condition

 

Allergies

 

Numbness

 

 

 

 

 

 

 

 

 

Vertigo

 

Carpal Tunnel

 

Arthritis

 

Seizure Disorders

 

TMJ

 

Compromised Immune System

 

Other not listed- please describe below

 

 

 

 

 

 

 

 

Please describe any areas of stiffness or pain, as best you can.

I have completed this client intake form to the best of my knowledge. I understand the massage services are designed to be a health aid and in no way substitute a physician’s care when indicated.

I understand massage therapists are not qualified to perform spinal adjustments, diagnose, prescribe, or treat any physical or mental illness. If I experience any pain or discomfort during the massage, I will immediately inform the therapist so that pressure/stroke many be adjusted to my

comfort. I agree to keep the therapist updated as to any changes in my medical profile and I understand there shall be no liability on the therapist’s part if I fail to do so.

Signature

 

Date

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