About this template
Streamline your practice's onboarding process with this comprehensive massage therapy client intake form. Designed specifically for massage therapists, wellness clinic owners, and physical therapists, this template collects essential background information needed to provide safe and personalized treatments. It captures crucial details including contact information, emergency contacts, current medications, known allergies, and specific areas of pain or discomfort.
The form also explores lifestyle factors such as daily physical duties, exercise habits, sleep positions, and prior injury or accident history. By gathering this medical and lifestyle data in advance, practitioners can identify contraindications, customize session plans, and ensure optimal care for every client. The digital format eliminates messy paper clipboards and allows clients to submit their health history easily from any device before arriving for their appointment.
Doc2Form makes it simple to convert this template into a ready-to-use Google Form in seconds. Safeguard your clients' health information while creating a smooth, professional intake workflow that sets the right tone for their therapeutic experience from the very first click.
Key features
- Collect detailed health history and pain points before the session.
- Capture emergency contact details and client occupation info.
- Identify prior injuries, surgeries, and current medications.
- Easy to customize and send to clients via email or text.
- Mobile-friendly format for quick completion on any device.
Use cases
- New client onboarding for independent massage therapists.
- Health and medical screening prior to spa treatments.
- Tracking chronic pain locations and physical therapy progress.
- Collecting digital liability waivers and consent for bodywork.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Enter your birth date.
- Email Address (Short answer)Where we can reach you with appointment confirmations.
- Phone Number (Short answer)Your primary contact number.
- Home 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.
- Emergency Contact Phone Number (Short answer)Phone number for your emergency contact.
- Occupation (Short answer)What is your current occupation or daily work routine?
- Current Medications (Paragraph)Please list any medications you are currently taking.
- Known Allergies (Paragraph)List any allergies, especially to oils, lotions, or nuts.
- Areas of Discomfort or Pain (Paragraph)Describe any specific areas on your body where you are experiencing pain or tension.
- Pain Level Today (Linear scale)Rate your current pain level on a scale from 1 (mild) to 10 (severe).
- Prior Injury or Accident History (Paragraph)Describe any significant accidents, surgeries, or prior injuries.
- Sleep Position (Multiple choice)What is your primary sleeping position?
- Client Consent and Signature (Short answer)Please type your full legal name as an electronic signature to confirm that the information provided is accurate and you consent to receive massage therapy.
FAQ
What essential details should be included in a massage client intake form?
An effective intake form should capture basic contact details, emergency contacts, current medications, allergies, existing medical conditions, specific areas of pain or discomfort, and a history of previous injuries or surgeries.
Why is it important to collect health history before starting a massage?
Reviewing health history helps practitioners identify contraindications—conditions where massage might be unsafe—and allows therapists to tailor techniques to the client's specific physical needs.
Can I customize the questions in this Google Form template?
Yes! Once you import this template using Doc2Form, you have full control in Google Forms to add, remove, or modify any questions to suit your specific practice.
How do clients submit this form before their appointment?
You can easily share the Google Form link via email, text message, or embed it on your website so clients can complete their intake paperwork ahead of time.
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.