About this template
A Massage Health History Form is an essential tool for massage therapists, wellness centers, and spas designed to collect vital medical background, injuries, allergies, and therapeutic goals from new clients. Prior to beginning any bodywork, understanding a client's health profile is crucial for ensuring safe, personalized sessions and avoiding potential contraindications.
Using Doc2Form, you can instantly turn this comprehensive health questionnaire into a ready-to-use Google Form. This enables you to seamlessly send digital intake packets to clients before their appointments, eliminating messy paper clipboards and saving valuable time at the front desk. Collected responses flow directly into your Google Drive, helping you maintain organized client records while keeping sensitive wellness data secure and easily accessible.
Key features
- Collect complete medical history and allergy alerts prior to appointments.
- Identify specific areas of tension, pain, or focus before the session starts.
- Seamlessly track physician care status and active medications.
- Built-in emergency contact collection for added client safety.
- Instantly convert into a Google Form with Doc2Form in seconds.
Use cases
New client onboarding at boutique massage studios and day spas.
Clinical massage therapy sessions addressing chronic pain or rehabili…
Clinical massage therapy sessions addressing chronic pain or rehabilitation.
Mobile massage therapists collecting digital intake forms on the go.
Wellness retreats requiring health clearances prior to scheduled trea…
Wellness retreats requiring health clearances prior to scheduled treatments.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Please provide your birth date.
- Email Address (Short answer)Where we can send your appointment confirmations and receipts.
- Phone Number (Short answer)Best number to reach you regarding your appointment.
- Address (Paragraph)Street address, city, state, and zip code.
- Emergency Contact Name (Short answer)Name of someone we can contact in case of an emergency during your visit.
- Emergency Contact Phone Number (Short answer)Phone number for your emergency contact.
- Are you currently under the care of a physician? (Multiple choice)Select yes if you are actively seeing a doctor for any ongoing health concerns.
- Physician Care Details (Paragraph)If you answered yes above, please describe the condition and treatment.
- Do you have any active medical conditions? (Multiple choice)E.g., high blood pressure, heart conditions, diabetes, epilepsy, blood clots.
- Medical Conditions Details (Paragraph)Please list any medical conditions we should be aware of.
- Are you currently taking any medications? (Multiple choice)Include prescription drugs, blood thinners, muscle relaxers, or pain relievers.
- Medications and Dosage (Paragraph)Please list the names of medications and their general purpose.
- Have you had any recent surgeries or serious injuries? (Multiple choice)Include any operations or trauma within the last 12 months.
- Surgery & Injury Details (Paragraph)Describe the procedure or injury and approximate date.
- Do you have any allergies or sensitivities? (Multiple choice)Include nut allergies, skin sensitivities, reactions to oils, lotions, or latex.
- Allergy Details (Paragraph)Please list any specific allergies or product sensitivities.
- Are you currently pregnant? (Multiple choice)Applicable for prenatal massage precautions.
- Pregnancy Trimester or Weeks (Short answer)If pregnant, please indicate how many weeks along you are.
- Areas of Concern or Focus (Checkboxes)Select the areas where you would like your therapist to focus or avoid.
- Additional Health Notes (Paragraph)Share any other information that will help us give you the best possible session.
- Client Signature (Short answer)Please type your full legal name to acknowledge that the information provided is accurate and complete.
- Signing Date (Date)Today's date.
FAQ
How do I use this template with Google Forms?
With Doc2Form, you can instantly convert this template into a fully editable Google Form with a single click. No manual retyping required.
Why is a health history form necessary for massage therapy?
It ensures the therapist is aware of any medical conditions, recent surgeries, or pregnancies that might make certain massage techniques or pressures unsafe for the client.
Can clients fill out this form on their mobile phones?
Yes! Google Forms are fully responsive and optimized for smartphones and tablets, allowing clients to complete their intake paperwork easily before arriving.
Where is the submitted client data stored?
All responses are securely saved in your Google Account, typically linked to a Google Sheet where you can review client profiles at a glance.
Can I edit the questions to match my specific spa services?
Absolutely. Once the template is in your Google Forms account, you can freely add, remove, or modify any questions to fit your practice.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.