About this template
The Massage Intake Google Form Template is designed to help massage therapists and wellness practitioners streamline their client onboarding process. By collecting critical health information, pain history, and contact details before the session begins, you can provide a more personalized and effective treatment experience. This template eliminates the need for paper forms at the front desk, allowing clients to fill out their information securely from any device.
This form covers essential areas including medical history, specific areas of discomfort, pain frequency, and previous injury details. It also includes sections for scheduling preferences and consent, ensuring you have all the necessary documentation to provide safe and professional care. Using Doc2Form to deploy this template allows you to maintain organized client records directly in your Google Drive, making it easier to prepare for sessions and track client progress over time.
Key features
- Comprehensive health history and symptom tracking sections.
- Mobile-friendly design for easy client completion.
- Integrated appointment request fields.
- Secure data storage directly in your Google Drive.
- Customizable fields to match your specific therapy style.
Use cases
New client onboarding for massage therapy clinics.
Collecting pre-session health disclosures for sports massage.
Tracking chronic pain progress for therapeutic massage clients.
Gathering liability waivers and contact info for mobile massage servi…
Gathering liability waivers and contact info for mobile massage services.
What this form collects
- Full Name (Short answer)Please enter your legal first and last name.
- Date of Birth (Date)Required for health record identification.
- Do you have any current health conditions or injuries? (Paragraph)List any medical conditions, recent surgeries, or injuries we should be aware of.
- Are you currently taking any medications? (Paragraph)Please list any prescription or over-the-counter medications.
- Where do you experience discomfort or pain? (Checkboxes)Select all areas that apply.
- On a scale of 1-10, how would you rate your typical pain level? (Linear scale)1 = No pain, 10 = Severe pain.
- What triggers your pain? (Paragraph)Describe activities or times of day that make your discomfort worse.
- Preferred Appointment Date (Date)Select your requested date.
- Electronic Signature (Short answer)Please type your full name to acknowledge that the information provided is accurate and you consent to treatment.
FAQ
Can I add my own clinic's policies to this form?
Yes. Once you convert this template, you can easily add a section at the beginning or end to include your specific cancellation policies, privacy notices, or service agreements.
Can I see the client's responses in a spreadsheet?
Absolutely. Google Forms automatically links to Google Sheets, allowing you to view, sort, and filter all your intake data in one organized table.
Can I accept payments through this form?
While Google Forms does not have a native payment gateway, you can include a link to your preferred payment processor in the confirmation message after the client submits the form.
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.