Massage Intake Form
Client Intake & Consent Form
To ensure the best possible care, please complete the Health History & Consent Form before your session. This form helps me understand your medical background, current concerns, and any specific needs so I can tailor your massage safely and effectively.
By signing, you acknowledge that massage therapy is for therapeutic purposes only and does not replace medical care. You also consent to treatment, agree to communicate any discomfort during the session, and confirm that you have disclosed relevant health information.
Your privacy is important—your information will remain confidential.
Please take a few moments to fill out the form before your appointment. Thank you!
Have you had a professional massage before?*
What type of massage are you seeking?*
What type of pressure do you prefer?*
Do you suffer from choronic pain?*
How long have you been experiencing the pain ? Please add dates and cause if you can. *
Are you coming in for an Acute injury (recent injury )*
If yes when did the injury happen and what was the cause ? Please give a date and reason for injury, if you can
Are you taking any medications?*
Please list name and use:
Are you currently pregnant?*
Do you currently have or have you ever experienced any of the following conditions? (Check all that apply)*
Explain any conditions marked above:
Do you have any allergies or senstivities?*
Are any areas you do not want massaged?*