Free Massage Intake Form Template
A standard one-page massage intake and consent form you can print, adapt and use. No sign-up, no email required.
Massage Client Intake and Consent Form
Practice name: Therapist: Date:
1. Client information
2. Reason for your visit
What would you like to get from today's session?
Areas you would like me to focus on:
Areas you would like me to avoid:
3. Health history
Check anything that applies now or applied in the past. This helps your therapist adjust the session. It does not diagnose anything.
- Recent surgery or injury
- High or low blood pressure
- Heart condition
- Blood clots or circulation problems
- Taking blood thinners
- Diabetes
- Cancer (past or current)
- Skin conditions or open wounds
- Allergies (oils, lotions, latex, nuts)
- Pregnancy (weeks: ____)
- Recent fever or contagious illness
- Osteoporosis
- Numbness or tingling
- Migraines or frequent headaches
- Joint or arthritis condition
- Other: ______________
Current medications and supplements:
Other health care providers you see (optional):
Anything else your therapist should know:
4. Comfort preferences
You will be properly draped during the session and only the area being worked on is uncovered. You can ask to adjust pressure, stop or change anything at any time.
5. Consent and acknowledgment
I have completed this form accurately to the best of my knowledge and will tell my therapist about any change in my health. I understand that massage therapy is not a substitute for medical care and is not used to diagnose or treat medical conditions. I understand I may ask to adjust or stop the session at any time. I consent to receive massage therapy from the practice named above.
Cancellation policy (practice to complete):
I have read and understand the cancellation policy.
Template from Massage Stream (massagestream.com). General information only, not legal or medical advice. Adapt it to your state, local and professional requirements before use.
Not legal or medical advice. This is a general template. Privacy, consent and record-keeping rules differ by state and profession. Adapt it to your state requirements and check with your professional association before use.
How to use this intake form
- Add your practice details. Fill in your practice name and write your own cancellation policy in the space provided. Our cancellation policy template has plain-language wording you can adapt.
- Collect it before the first session. A form completed ahead of time saves 10 minutes of the appointment. Print it, email the PDF, or collect it online.
- Read it before the client is on the table. Anything checked in the health history section is a prompt for a question, not a conclusion. Follow your professional training and refer to a health provider when appropriate.
- Keep it as your records require. Store paper forms securely and follow the retention rules that apply to you.
What each section is for
Client information
Name, contact details and an emergency contact. Ask only for what you will use. Less personal data is less to protect.
Reason for visit and preferences
The goals and pressure preference set expectations for the session. Areas to avoid are as important as areas to focus on, and many clients will not volunteer them unless asked.
Health history
The checklist flags conditions a therapist may need to know about so you can adjust the session or decide whether massage is appropriate. It is not a diagnostic tool, and the form does not make any claim about health outcomes.
Consent and cancellation acknowledgment
A signed acknowledgment records that the client understands draping, can stop at any time, and has seen your policy. Having the client tick the policy line makes a later late-cancel conversation easier.
Variations
Chair massage, prenatal massage and sports massage each need different questions. See our guide to chair and prenatal massage intake forms for what to add or remove.
Collect it digitally
If you would rather not print and scan, Massage Stream includes client intake forms that go out before the first visit, alongside online booking and reminders. Pricing is shared on a quick call, and there is a 14-day money-back guarantee.
Frequently asked questions
What should a massage intake form include?
Most include client contact details, an emergency contact, the reason for the visit, health history and medications, areas to focus on or avoid, pressure preference, a consent statement, a cancellation policy acknowledgment and a signature with a date. Add anything your state, profession or insurer requires.
Is a massage intake form required?
Requirements vary by state, profession and employer. Many therapists use one as standard practice. Check your state board or professional association for what applies to you.
How long should I keep client intake forms?
Record retention rules vary by state and by whether you bill insurance. Check your state requirements and professional association guidance, and ask a qualified adviser if you are unsure.
Can clients fill in the form before they arrive?
Yes. Massage Stream can send intake forms before the first visit so the first session starts with the work instead of a clipboard.
Is this template legal or medical advice?
No. It is a general starting point. Adapt it to your state, local and professional requirements before using it.
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