TemplatesMassage
massage intake form
Massage contraindications split into two groups that behave completely differently: the ones where you avoid an area, and the small number where you do not treat at all.
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- screening questions
- 10screening questions
- stop the appointment
- 3stop the appointment
- minutes to set up
- 10minutes to set up
- a month to start
- $8a month to start
Massage intake and consent
Full name
Date of birth
Email
Phone
Have you had surgery or an injury in the last 3 months?
YesNo
Blood clot or DVT
Why this form, specifically
It puts the clot question at the top and asks it every visit, closing the gap that opens once a client relationship becomes familiar enough to skip the form.
Look before you download
The whole document, before you give us anything
Massage intake and consent
Your details
Full name
Date of birth
This is where your aftercare instructions go.
Phone
Health questions
Have you had surgery or an injury in the last 3 months?
Do you have high or low blood pressure?
Do you take blood thinners, or aspirin daily?
This is the form you get
Not a sample, not a preview of a preview. Every question below is in your account ten minutes after you sign up, with the flags already set and the aftercare email already written.
- 14-day trial
- No card needed
- Set up in 10 minutes
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The 10 answers that should stop you
Massage contraindications split into two groups that behave completely differently: the ones where you avoid an area, and the small number where you do not treat at all. Knowing which is which is exactly what the intake form is for, and it is why the clot question sits at the top rather than in the middle.
Do not treat
3WhyPressure over a deep vein thrombosis can dislodge the clot. This is the one absolute contraindication every massage curriculum leads with.
What goes wrong if you treat anywayPulmonary embolism. This is the reason the question is on the form.
What to doDo not treat until their doctor confirms it is resolved and clears them in writing.
The question that catches itDo you have, or have you had, a blood clot or DVT?
WhyMassage increases circulation, which can spread a systemic infection and worsen how the client feels.
What goes wrong if you treat anywayA sicker client, and an infection risk to you and the next person in the room.
What to doRebook. Have a clear no-charge sick policy so people are not financially motivated to come in ill.
The question that catches itAre you unwell, or do you have a fever today?
WhyDirect contact spreads impetigo, fungal infections and scabies efficiently.
What goes wrong if you treat anywayTransmission to you, to your linens and to the next client.
What to doAvoid the area, or postpone if it is widespread. Change and hot-wash all linens either way.
The question that catches itDo you have any skin infection, rash or open wounds?
Proceed with caution
7WhyDeep pressure causes micro-bleeding into tissue that anticoagulated blood does not stop quickly.
What goes wrong if you treat anywayExtensive bruising from pressure that would be unremarkable on anyone else.
What to doLight to medium pressure only, and check in during the session rather than after.
The question that catches itDo you take blood thinners, or aspirin daily?
WhyFirst-trimester caution is convention rather than strong evidence, but positioning matters throughout and supine work is inadvisable later on.
What goes wrong if you treat anywayDiscomfort, dizziness from vena cava compression, and an insurer who expects a pregnancy qualification.
What to doSide-lying with support from the second trimester. Check your insurance covers pregnancy massage before you offer it - many base policies do not.
The question that catches itAre you pregnant or breastfeeding?
WhyHealing tissue and scar formation are disrupted by direct pressure, and post-surgical clot risk is elevated.
What goes wrong if you treat anywayDisrupted healing, pain, and in the early window a clot risk.
What to doAvoid the site entirely. For major surgery, ask for surgical clearance before any work at all.
The question that catches itHave you had surgery or an injury in the last 3 months?
WhyMassage lowers blood pressure. On someone already low, standing up afterwards is the risk.
What goes wrong if you treat anywayDizziness or fainting at the end of the session.
What to doSit them up slowly, offer water, and do not leave the room while they get off the table.
The question that catches itDo you have high or low blood pressure?
WhyThe old blanket contraindication has been retired, but lymphoedema risk, bone metastases and port sites all need specific accommodation.
What goes wrong if you treat anywayHarm at a fragile site, or a lymphoedema flare, from a technique chosen without knowing.
What to doOncology massage training or a doctor's clearance. Avoid radiotherapy fields, ports and any limb at lymphoedema risk.
The question that catches itDo you have a condition, or take medication, that affects healing or immunity?
WhyReduced bone density makes ribs and vertebrae vulnerable to firm pressure.
What goes wrong if you treat anywayA rib fracture from pressure the client asked for.
What to doLight pressure, avoid direct spinal and rib work, and do not increase pressure on request.
The question that catches itDo you have osteoporosis or any bone condition?
WhyNeuropathy means reduced sensation, so the client cannot reliably tell you the pressure is too much.
What goes wrong if you treat anywayTissue damage the client does not feel happening.
What to doModerate pressure, inspect feet and lower legs before working on them, and check in verbally more often.
The question that catches itDo you have diabetes?
What you actually get
Nobody buys a consent form
They buy the fifteen minutes back at the start of an appointment. They buy the phone call they did not have to make, because the contraindication turned up two days early instead of two minutes late. They buy an insurer who pays out, because the patch test has a timestamp rather than a memory attached to it.
The form is the mechanism. What you are actually buying is the record it leaves behind.
That is the whole argument, and it is why the questions matter more than the software. A blank form builder hands you a canvas and calls it flexibility. This hands you the nine questions that a waxing client should be asked, in the wording that gets an honest answer, with the risky one already flagged in red.
What this saves you
Not what the form contains - what it gives you back. Every number below is arithmetic you can check on the calculator further down the page.
12 hours
a year, back in your chair
A new client filling in a paper form in your treatment room costs ten to fifteen minutes of an appointment they already paid for. Send it with the booking confirmation and that time goes back into treating, at roughly twelve hours a year on twenty clients a week.
Before they sit down
not halfway through
A form that collects answers and does nothing with them has solved the wrong problem. A risky answer turns the submission red and names the reason at the top, at the only moment the information is worth anything.
Seconds
to find any client's form
The reason to leave paper is not the signing, it is the finding. When a health inspector or a solicitor asks for one specific record from eighteen months ago, you search a name instead of an afternoon.
A defensible claim
instead of a disputed memory
Most professional policies in these trades condition cover on documented screening, and a patch test you can describe is not a patch test you can produce. A timestamped record is the difference between a claim your insurer defends and one they decline.
Same week. One thing changed.
The left-hand column is most studios today. The right-hand one is the same week with the form sent at booking instead of handed over on arrival.
- Your regular mentions her calf has ached since a flight
- The intake update became a two-sentence chat months ago
- You work the area, because that is what she asked for
- Nothing on paper says you asked about clots since her first visit
Nothing here is negligent. It is just undocumented.
- A fifteen-second health re-check goes out before every session
- The flight and the calf pain are answered before she arrives
- The clot question is flagged, and you refer instead of treating
- Every session's consent, including draping, is on the record
Same treatments, same clients, same you. Different record.
Try the flag
Answer these as if you were the client
Answer honestly and nothing happens. Answer yes to the one that matters and watch what lands on your side.
What the client sees
Do you have, or have you had, a blood clot or DVT?
Are you unwell, or do you have a fever today?
Do you take blood thinners, or aspirin daily?
Are you pregnant or breastfeeding?
What you see
Answer honestly and nothing happens. Answer yes to the one that matters and watch what lands on your side.
In your submissions list
Massage
What goes wrong without it
A client mentions calf pain and asks for deep work on it.
She has been on a long-haul flight three days earlier, and the pain is a DVT, which she does not know and which is not obviously distinguishable from a strain to anyone without medical training. The therapist works the calf deeply for fifteen minutes. What follows is the reason the question exists. It is worth being clear about what a form does here: it does not diagnose the clot. What it does is create the moment where the client says 'I flew back from Singapore on Tuesday and my calf has hurt since', and the therapist declines and refers. The form's job is not clinical judgement - it is prompting the disclosure that makes judgement possible.
What a massage intake form has to cover
The actual field list, and why each group is on this particular form.
Contact and emergency
- Full name
- Date of birth
- Phone
- Emergency contact
- Doctor's name, optional
The emergency contact is standard in this trade in a way it is not elsewhere, because a client is unclothed, alone with you in a closed room, and occasionally faints on standing up.
Absolute screening
- Blood clot, DVT or a history of clots
- Fever or feeling unwell today
- Contagious skin condition or open wounds
- Recent surgery in the last 3 months
The clot question leads every massage curriculum for one reason: pressure over a deep vein thrombosis can dislodge it. It is the only question on this form where the worst outcome is fatal, and it belongs at the top rather than buried at position fourteen.
Conditions and medication
- Blood thinners
- High or low blood pressure
- Diabetes and any neuropathy
- Osteoporosis or fragility fractures
- Cancer, current or recent treatment
- Pregnancy and trimester
- Epilepsy
- Current medication
The neuropathy follow-up on diabetes is the detail generic forms miss. A client who cannot feel pressure cannot tell you it is too much, which changes how you work on the legs and feet entirely.
The body and the session
- Areas of pain or tension
- Injuries, current and historic
- Areas to avoid
- Pressure preference
- Previous massage experience
- What you want from today's session
'Areas to avoid' is the single most useful line on a massage form and the one most likely to be left blank on paper. Digitally it can be required, which is why digital forms get better answers.
Consent and boundaries
- Draping consent and explanation
- Consent to work on specific areas
- Right to stop or adjust at any time
- Cancellation policy
- Signature with timestamp
Draping consent is not a formality in this trade. It is the clearest professional boundary a therapist has, and having it in writing protects both parties in a way nothing else on the form does.
Is a digital signature legally valid?
Exact time signed
IP address
Device and browser
The exact form they saw
Yes - the US ESIGN Act and the state UETA adoptions give it the same legal effect as ink. What makes it hold up is the evidence stored beside it, and a paper form in a drawer carries none of this.
Sign with your fingerDraw a signature with your mouse or trackpad
Where you stand legally
Massage therapy is licensed in the large majority of US states, and licensing brings documentation obligations that are usually more explicit than in the beauty trades. Many state boards require client records to be kept for a specified period - commonly four to seven years - and require them to be produced on request. Scope of practice is drawn tightly: massage therapists do not diagnose, do not adjust, and in most states do not perform any technique that crosses into physical therapy or chiropractic. Recording a client's stated condition is fine; naming a condition yourself is not. Two further points matter practically. First, pregnancy massage is excluded from a number of base insurance policies unless the therapist holds a specific qualification, and a first-trimester client is where that gap gets discovered. Second, draping and consent for work on sensitive areas is both an ethical requirement and, in several states, a regulatory one with defined standards. Document both. Check your board and your policy; this is not legal advice.
Paper, PDF or digital?
Paper
Fine when you are small
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Emailed PDF
Worst of both
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Digital
Earns its place at scale
- Signed before they arrive
- Flags contraindications
- Findable by name in seconds
- Proves when it was signed
- Sends aftercare automatically
- Costs nothing
Three clients a week? Print it and staple it in a binder. That is genuinely fine, and software would be an expense with no return. Digital earns its place around ten to fifteen clients a week, when finding one form again matters more than the minutes it took to file it.
Questions people actually ask
A known or suspected blood clot or DVT, fever or active systemic infection, and contagious skin conditions on the area. Everything else on a massage form is an area to avoid or a technique to modify rather than a reason not to treat.
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General guidance for professionals, not legal or medical advice. Check the rules that apply where you work.