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Massage Therapy Intake Form template

A free massage therapy intake form with focus areas, areas to avoid, pressure preference, contraindication screening, and a signed acknowledgment. Send it as a link before the appointment.

Massage Therapy Intake Form

About you

Full name *

Date of birth *

Phone number *

Email address *

Emergency contact name and phone *

Your visit

Have you had a professional massage before? *

What is your main goal for this session? *

Areas you'd like us to focus on *

Areas to avoid

Preferred pressure *

Health history

Do any of these apply to you? *

Please describe any condition you checked above

Current medications

Are you currently under a doctor's care? *

For what condition? *

Acknowledgment

Massage therapy is for relaxation and relief of muscle tension. It does not replace medical diagnosis or treatment. I will tell my therapist right away if I feel discomfort during the session, and I'll update this form if my health changes.

I understand and agree *

Signature — type your full legal name *

Date signed *

7 questions every massage intake form needs

  1. Goal for the session
  2. Areas to focus on
  3. Areas to avoid
  4. Pressure preference
  5. Pregnancy and recent injuries
  6. Allergies to oils or lotions
  7. Doctor's care and medications
What's included
  • Full name
  • Date of birth
  • Phone number
  • Email address
  • Emergency contact name and phone
  • Have you had a professional massage before?
  • What is your main goal for this session?
  • Areas you'd like us to focus on
  • Areas to avoid
  • Preferred pressure
  • Do any of these apply to you?
  • Please describe any condition you checked above
  • Current medications
  • Are you currently under a doctor's care?
  • For what condition?
  • I understand and agree
  • Signature — type your full legal name
  • Date signed
Prefer paper? Print it

Download this form as a PDF or Word file — free, no account. When you're ready, send the same form as a link so nobody retypes a clipboard.

This template is a starting point, not legal or medical advice, and using it does not by itself make your practice HIPAA compliant. To collect patient health information on TendForm, use the HIPAA plan with a signed Business Associate Agreement, and have your own counsel review consent and policy wording.