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 intake form template, sample massage therapy intake form, massage forms

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.


How to Edit Massage Intake Form Online for Free

This PDF editor was developed to be as straightforward as possible. Since you use the next actions, the process of filling out the massage therapy forms file will undoubtedly be trouble-free.

Step 1: The first thing is to press the orange "Get Form Now" button.

Step 2: At this point, you're on the form editing page. You can add text, edit current details, highlight certain words or phrases, place crosses or checks, insert images, sign the template, erase unnecessary fields, etc.

Fill out all of the following parts to create the form:

part 1 to filling in massage therapist intake forms

Provide the expected particulars in the space Please review this list and check, arthritis diabetes blood clots, and depression panic disorder other.

Finishing massage therapist intake forms stage 2

You should identify the necessary details in the If any of the above needs to be, and please do so part.

Filling in massage therapist intake forms stage 3

You will need to define the rights and obligations of both parties in field Do you have any of the following, skin rash, coldflu, open cuts severe pain, anything contagious, injuriesbruises, Do you have any allergies to, medications, foods nuts etc, environmental allergens dust, reactions to skin care products, If any of the above are checked, Are you wearing, contact lenses hearing aid, and Please indicate with an X if any.

Finishing massage therapist intake forms step 4

Check the sections What are your goalsexpectations, The following sometimes occurs, Please read the following, reduce muscular tension it is not, This is a therapeutic massage and, session and I will be liable for, Being that massage should not be, I have answered all questions, and Signature Date and then complete them.

Finishing massage therapist intake forms part 5

Step 3: Click the Done button to be certain that your completed file may be exported to every electronic device you select or sent to an email you indicate.

Step 4: Make copies of your file - it may help you avoid possible complications. And don't be concerned - we cannot disclose or view your information.

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