Massage Intake Form PDF Details

If you are a massage therapist, you know that the Massage Intake Form is an important part of your business. The form allows you to gather important information about your clients, including their health history and any specific concerns they may have. By having this information on hand, you can provide your clients with the best possible massage experience. In this blog post, we will discuss the importance of the Massage Intake Form and share some tips for completing it correctly.

We have gathered some interesting information regarding the massage intake form. You'll have the projected time you will need to fill out the form and a few other details.

Form NameMassage Intake Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesmassage intake forms download, massage form, massage form template, massage forms form

Form Preview Example


WELCOME! I would like to make your appointment as pleasant and comfortable as possible. If at any time you have questions regarding your session, please let me know.







Date of birth




























Home Phone












Work Phone






Have you ever received massage therapy?





Type of massage experienced (swedish, shiatsu, deep tissue, etc.)

Are you currently taking any medications?





If yes, please list name and reason for medications

Are you currently seeing a healthcare professional?





If yes, please list names and reason/treatment

Please review this list and check those conditions that have affected your health either recently or in the past. Place a check mark next to the condition.

arthritis diabetes blood clots broken/dislocated bones bruise easily

cancer chronic pain constipation/diarrhea auto-immune condition* hepatitis (A, B, C, other) skin conditions stroke

surgery TMJ disorder

(*AIDS, fibromyalgia, chronic fatigue, lupus, etc.)

depression, panic disorder, other psych condition

diverticulitis headaches heart conditions back problems high blood pressure insomnia

muscle strain/sprain pregnancy scoliosis seizures whiplash

chemical dependency (alcohol, drugs)

If any of the above needs to be detailed or if there is anything else to share,

please do so:

Do you have any of the following today:

skin rash




open cuts


severe pain

anything contagious





Do you have any allergies to:



foods (nuts, etc.)

environmental allergens (dust, pollen, fragrances)

reactions to skin care products

If any of the above are checked, please give details:

Are you wearing:


contact lenses


hearing aid



Please indicate with an (X), if any, the areas in which you are feeling discomfort:

What are your goals/expectations for this therapy session?

The following sometimes occurs during massage. They are normal responses to

relaxation. Trust your body to express what it needs to:

need to move or change position ! sighing, yawning, change in breathing

stomach gurgling ! emotional feelings and/or expression

movement of intestinal gas ! energy shifts ! falling asleep ! memories

Please read the following information and sign below:

1.I understand that although massage therapy can be very therapeutic, relaxing and reduce muscular tension, it is not a substitute for medical examination, diagnosis and treatment.

2.This is a therapeutic massage and any sexual remarks or advances will terminate the session and I will be liable for payment of the scheduled treatment.

3.Being that massage should not be done under certain medical conditions, I affirm that I have answered all questions pertaining to medical conditions truthfully.


Watch Massage Intake Form Video Instruction

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