About this template
A professional Massage Therapy Consent Form is an essential tool for any massage practice, ensuring that both the therapist and the client are aligned on expectations, health history, and safety. This template provides a structured way to collect vital information, including emergency contacts, medication lists, and specific health conditions that might impact treatment. By gathering this data upfront, therapists can tailor their sessions to be both safe and effective.
Beyond basic contact details, this form includes a comprehensive health questionnaire and a formal consent waiver. This allows clients to disclose injuries, allergies, or medical conditions, while simultaneously acknowledging the nature of the service. Using Doc2Form to digitize this process helps maintain a clean, organized record of client agreements, which is vital for professional practice management and building trust with your clientele.
Key features
- Collect comprehensive health and medical history.
- Capture emergency contact details for safety.
- Standardized consent waiver for professional compliance.
- Mobile-friendly format for easy client completion.
- Easily export responses to Sheets for quick review.
Use cases
- New client onboarding for massage therapy clinics.
- Pre-session health screening for mobile massage services.
- Annual updates for returning massage therapy clients.
- Spa and wellness center intake procedures.
What this form collects
- Full Name (Short answer)Please provide your legal first and last name.
- Date of Birth (Date)Used for identification and age-appropriate treatment planning.
- Phone Number (Short answer)Best number to reach you for appointment reminders.
- Emergency Contact Name (Short answer)Name of the person to contact in an emergency.
- Relationship (Short answer)e.g., Spouse, Parent, Friend.
- Emergency Contact Phone (Short answer)Phone number for your emergency contact.
- Do you have any known allergies? (Paragraph)List any allergies to oils, lotions, or other substances.
- Are you currently taking any medications? (Paragraph)List medications that may affect your massage treatment.
- Do you have any current injuries or medical conditions? (Paragraph)Please describe any areas of pain, recent surgeries, or chronic conditions.
- Are you currently pregnant or nursing? (Multiple choice)This is important for your safety and comfort.
- Informed Consent Statement (Multiple choice)I understand that massage therapy is for stress reduction and relief of muscular tension. I understand that the therapist does not diagnose illness or disease. I agree to inform the therapist of any discomfort I may feel during the session.
- Client Signature (Short answer)Please type your full name to serve as your digital signature.
- Date Signed (Date)Today's date.
FAQ
Why should I use a digital consent form for massage therapy?
Digital forms are easier for clients to complete on their phones before arrival, saving time in the lobby and ensuring you have all the necessary health data before the session begins.
Can I customize the medical questions in this template?
Yes. Once you convert this template to a Google Form, you can easily add, remove, or edit questions to suit your specific massage techniques or clinic requirements.
How do I ensure client privacy with this form?
Google Forms provides secure access controls. Ensure you only share the form link with your clients and manage the responses within your private Google Drive account.
Is this form suitable for all types of massage?
Yes, it covers general health history and informed consent, making it appropriate for everything from deep tissue massage to relaxation therapy.
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.