TemplatesMassage therapy
massage therapy intake form
A therapeutic intake form carries more clinical weight than a spa one, because the client arrives with a complaint rather than a preference.
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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 records what the client reports rather than what you concluded, which is the line between a professional record and a diagnosis outside your scope.
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.
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- No card needed
- Set up in 10 minutes
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The 10 answers that should stop you
A therapeutic intake form carries more clinical weight than a spa one, because the client arrives with a complaint rather than a preference. That raises both the screening standard and the scope-of-practice risk, and the form has to serve both.
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 therapy
What goes wrong without it
A regular client has been coming for eight months for lower back pain that is improving.
She mentions in passing that her calf has been aching since a flight. The therapist, who is excellent and has treated this client thirty times, works the area because that is what the client asks for and because their relationship is comfortable enough that the intake update has become a two-sentence chat rather than a form. The clot question has not been asked since the first appointment. This is the specific failure mode of a long client relationship: the screening does not lapse because anyone is careless, it lapses because the form stopped being part of the routine once the relationship became familiar.
What a massage therapy intake form has to cover
The actual field list, and why each group is on this particular form.
Client and referral
- Full name
- Date of birth
- Contact details
- Emergency contact
- Referring practitioner if any
- Reason for referral
The referral fields separate a therapeutic practice from a spa. A client sent by a physiotherapist arrives with a stated goal, and recording it keeps you inside your scope while working alongside someone else's treatment plan.
Presenting complaint
- Primary complaint
- Onset and duration
- What makes it better or worse
- Pain scale today
- Previous treatment for it
- Body map marking
A body map gets better information than a text box, because clients point accurately and describe badly. It is also the field that makes progress visible across a course of sessions.
Medical screening
- Blood clot or DVT history
- Recent surgery or injury
- Cancer, current or in remission
- Osteoporosis
- Blood pressure
- Diabetes and neuropathy
- Blood thinners and other medication
- Pregnancy
- Skin conditions and open wounds
Cancer belongs here as a caution rather than a stop. The old blanket contraindication has been retired, but lymphoedema risk, bone metastases and port sites all need specific accommodation you cannot make without knowing.
Consent, scope and boundaries
- Draping consent
- Consent for specific areas including gluteal and abdominal work
- Acknowledgement that massage therapy is not diagnosis or medical treatment
- Right to stop at any time
- Signature with timestamp
The 'not diagnosis' acknowledgement is worth its line. It sets the client's expectation correctly and it records that the scope boundary was explained, which is the first thing a board asks about.
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
Therapeutic massage is where scope of practice becomes a live issue rather than a theoretical one, because clients arrive describing symptoms and hoping for a diagnosis. In every US state, massage therapists do not diagnose. Recording what the client reports is correct practice; writing your own assessment of what is wrong with them is not, and the distinction shows up in how the intake form is worded - 'client reports sciatic-type pain' is a record, 'sciatica' is a diagnosis. Where a client is referred by a physiotherapist, chiropractor or physician, keep the referral and work within it rather than expanding on it. Two further obligations recur across state boards: record retention, commonly four to seven years with production on request, and documented consent for work on sensitive areas, which several states define specifically. If you bill insurance or work under a healthcare provider's supervision, HIPAA may apply to your records in ways that do not apply to a spa practice, which changes how you store and share them. Check your own board. 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
Depth on the presenting complaint. A therapeutic intake adds onset, duration, aggravating factors, a pain scale and a body map, plus referral details - because the client arrived with a problem rather than a preference.
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General guidance for professionals, not legal or medical advice. Check the rules that apply where you work.