About this template
A remedial massage intake form is essential for capturing vital client health history, identifying injury areas, and ensuring safe treatment delivery. Massage therapists, physical therapists, and wellness clinic owners use this intake form to gather background details before a client's first appointment, including current medications, underlying health conditions, previous treatments, and specific pain points.
Collecting this information beforehand allows practitioners to tailor treatment plans, avoid contraindications, and focus entirely on recovery during the session. Using Doc2Form, you can instantly turn your intake process into a clean, mobile-friendly Google Form that clients can complete easily from their phone or computer before arriving. Streamline your clinic's onboarding workflow, eliminate clunky paper clipboards, and securely organize all client responses in your connected Google Sheets.
Key features
- Collect complete health history and injury details prior to sessions
- Mobile-friendly layout for quick client completion on any device
- Automatically syncs all responses directly to Google Sheets
- Reduces clinic front-desk clutter and manual paperwork
Use cases
New client onboarding at physical therapy and massage clinics
Pre-session health screening for targeted pain relief and sports reco…
Pre-session health screening for targeted pain relief and sports recovery
Gathering informed consent and emergency contact information
What this form collects
- Full Name (Short answer)Enter your first and last name.
- Phone Number (Short answer)Provide a reliable phone number where we can reach you regarding your appointment.
- Email Address (Short answer)Where should we send your appointment confirmations and receipts?
- Date of Birth (Date)Enter your birth date (MM/DD/YYYY).
- Occupation (Short answer)Your daily work activities help us understand repetitive strain patterns.
- Reason for Consultation (Paragraph)Describe the main symptoms, pain, or goals you want to address during your session.
- Affected Areas (Paragraph)Select or list the areas of your body that are currently causing discomfort.
- Current Medications (Paragraph)List any prescription medications, blood thinners, or pain relievers you are currently taking.
- Relevant Health Conditions (Checkboxes)Check any conditions that apply to you currently or in the past.
- Physician Care Status (Multiple choice)Are you currently under the care of a physician for any major medical condition?
- Other Treatments or Therapies (Short answer)List any chiropractic, physiotherapy, acupuncture, or other bodywork you are currently receiving.
- Exercise or Activity Details (Paragraph)Describe your typical weekly exercise routine, sports, or physical hobbies.
- Referral Source (Dropdown)How did you hear about our clinic?
- Client Acknowledgment & Signature (Short answer)Type your full legal name here to confirm that the information provided above is accurate and that you consent to receiving remedial massage therapy.
- Signing Date (Date)Enter today's date.
FAQ
How do clients access and fill out this intake form?
Once your template is generated as a Google Form, you can simply share the link via email, SMS, or post it directly on your clinic website so clients complete it prior to arrival.
Can I customize the questions to match my clinic's specific needs?
Yes! Because the form lives in your Google Drive, you have full freedom to add, remove, or edit any questions using the standard Google Forms editor.
Where is client response data stored?
All submissions are stored securely in your Google account and automatically organized into a linked Google Sheets spreadsheet for easy review.
Is this template free to use?
Yes, Doc2Form provides this template as a free resource to help you instantly create your Google Form without manual rebuilding.
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.