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Massage intake form Revised docx 2026

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The document is a confidential client intake form for Fitness Plus Therapeutic Massage, collecting personal information, massage preferences, medical history, and consent for treatment. It includes sections on emergency contacts, previous massage experiences, areas of pain, medical conditions, and policies regarding cancellations and privacy.

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Click ‘Get Form’ to open the Massage intake form Revised docx in the editor.
Begin by filling out your personal information, including your name, phone number, date of birth, and address. Ensure all details are accurate for effective communication.
Next, provide your email and occupation. Indicate your gender and emergency contact details for safety purposes.
In the Massage Information section, specify how you heard about the service and whether you have had a professional massage before. Select your preferred pressure level and type of massage.
Indicate any sensitivities to fragrances or skin conditions. Use the body diagrams provided to mark areas of pain or tension that require attention.
Complete the Medical History section by answering questions regarding chronic pain, medications, surgeries, and any relevant medical conditions.
Finally, read through the Informed Consent and Cancellation/Late Policy sections carefully. Sign and date where indicated to confirm your understanding and agreement.

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2018	4.3 Satisfied (33 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I create a massage intake form?

How to Create a Massage Client Intake Form Step 1: Create a new Google Form. Step 2: Include questions for personal information. Step 3: Add a field to describe health history. Step 4: Add a field to mention areas of concern. Step 5: Include necessary consent agreements. Step 6: Create an intake document automatically.

What is an example of a disclaimer statement?

I am aware that therapeutic massage is not a substitute for medical examination or diagnosis, and it is recommended that I see a health care provider for those services. I accept that massage promises no long-term cures nor will it alleviate my health problems.

How do you document massage therapy?

SOAP notes are a standard way of documenting massage therapy sessions. They allow you to track the progress of your clients, as well as provide information to insurance companies and other professionals. In this blog post, we will discuss how to write massage therapy SOAP notes, as well as provide some examples.

What is an example of a massage disclaimer?

I understand that massage or bodywork should not be perceived by me as a substitute for medical examination, diagnosis, or treatment and that I should consult a physician, chiropractor, or other qualified medical specialist for any mental or physical condition that I am aware of.

What is an example of a disclaimer physical activity?

I understand and am aware that my participation in the Event involves risk, including, but not limited to, travel, physical activity, locales where public health and safety may be at risk, or activities that involve risk that I create for others or others may create for me.

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Does a massage therapist massage the groin?

Professional massage therapists adhere to strict ethical and professional boundaries. Massaging the groin area is generally considered inappropriate and outside the scope of a therapeutic massage. Any discomfort or unease in this regard should be communicated to the therapist immediately.

What is an example of consent for massage therapy?

Please understand that when participating in any exercise or physical activity program there is a possibility of physical injury, and choosing to engage in this exercise or exercise program is done so at your own risk. If the activity seems too rigorous for you, please take a break.