About this template
A Myotherapy or Remedial Massage Intake Form is an essential tool for bodywork professionals looking to streamline client onboarding and gather crucial health details before a session. This digital intake form allows you to efficiently collect contact information, medical and trauma history, current medications, lifestyle habits, and specific areas of pain or discomfort.
By gathering this information ahead of time, practitioners can review client conditions in advance, prepare tailored treatment plans, and ensure safe, effective care. Moving away from clipboards and paper forms eliminates clutter, reduces manual data entry, and keeps client records organized in one secure place.
Doc2Form makes it easy to convert, customize, and deploy this intake template directly to your clients via a simple link or email before their appointment. Clients can complete the form on any smartphone, tablet, or computer, ensuring a smooth, professional start to their therapeutic journey.
Key features
- Collect complete health and injury histories before the session starts.
- Pinpoint exact areas of pain, tension, and discomfort.
- Understand client exercise habits, medications, and previous treatments.
- Set session preferences regarding conversation and pressure.
- Mobile-friendly format for easy completion on phones or tablets.
Use cases
New client onboarding for remedial massage clinics and myotherapy pra…
New client onboarding for remedial massage clinics and myotherapy practices.
Collecting informed health backgrounds prior to sports massage therapy.
Pre-treatment assessment for injury rehabilitation and chronic pain m…
Pre-treatment assessment for injury rehabilitation and chronic pain management.
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Mobile Phone Number (Short answer)We will use this number for appointment reminders.
- Email Address (Short answer)Where we can send your appointment confirmation and receipts.
- Date of Birth (Date)Please enter your date of birth.
- Home Address (Paragraph)Enter your street address, city, and postal code.
- How did you hear about us? (Dropdown)Select the option that best describes how you found our practice.
- Medical & Trauma History (Paragraph)Please list any past surgeries, serious injuries, fractures, or medical conditions.
- Current Medications & Supplements (Paragraph)List any prescription medications, OTC drugs, or herbal supplements you currently take.
- Weekly Exercise Status (Multiple choice)How often do you engage in physical exercise or sports?
- Common Physical Activities (Short answer)Describe your typical daily activities, hobbies, or sports.
- Reason for Consultation (Paragraph)What are your primary goals or symptoms for today's session?
- Affected Areas (Checkboxes)Select all areas where you are currently experiencing pain or tension.
- Previous Treatments (Paragraph)Have you received treatment for this issue before? If yes, what helped?
- Session Conversation Preference (Multiple choice)How do you prefer to experience your treatment?
- Acknowledgment & Signature (Short answer)By typing your full name below, you confirm that the information provided is accurate and consent to treatment.
- Date of Completion (Date)Today's date.
FAQ
How do clients complete this intake form?
You can easily share the form link via email, SMS, or QR code prior to their appointment so they can fill it out on their phone or computer.
Can I customize the questions on this form?
Yes! Once generated in Google Forms, you can fully edit, add, or remove any questions to suit your specific practice requirements.
Is client health data stored securely?
All responses are saved securely in your Google Drive account, adhering to your organization's standard Google Workspace security practices.
Can I collect client signatures using this template?
You can include a confirmation and acknowledgement text block or agreement question, or link out to a dedicated waiver if required by your clinic.
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.