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Massage therapy intake form

Health history, pressure preference and the areas to avoid — answered before the client is face down and cannot easily talk.

Free, and no account needed to start. Send the link however you normally would: text, email, or a group chat. People fill it in on their phones. Sort the answers, search them, download them as a spreadsheet. 100 replies a month on the free plan.

Or download the printable PDF. Free, no email address, ready to print and pin up.

Already have your own version? Upload it and keep your wording.

The form people fill in, and the list you get back

This is the real form, not a screenshot of one, and it works. Below it is what you see as the answers come in.

Massage intake and consent

25 questions · takes about 6 min

Areas you would like worked on

Select all that apply.

Pressure preference
Do any of these apply to you?

Select all that apply.

Have you had massage therapy before?
Signature
Sign above with your finger or mouse

By signing here I agree that this signature, and the answers submitted with it, are mine and have the same effect as a signature on paper.

All 25 questions

  1. Full name (required)
  2. Pronouns
  3. Date of birth (required)
  4. Phone number (required)
  5. Email address
  6. Date of appointment (required)
  7. Therapist
  8. Emergency contact — name and relationship (required)
  9. Emergency contact — phone number (required)
  10. What brings you in today? (required)
  11. Areas you would like worked on (required)
  12. Areas to avoid entirely
  13. Pressure preference (required)
  14. Do any of these apply to you? (required)
  15. If you ticked anything above, tell us a little more
  16. Medications and supplements
  17. Allergies, including to oils, lotions, nuts and latex
  18. How would you rate your discomfort today, from 0 to 10? (required)
  19. Have you had massage therapy before? (required)
  20. I understand I may ask the therapist to adjust pressure, change area or stop at any point, for any reason (required)
  21. I understand I will be draped throughout and that only the area being worked on is uncovered (required)
  22. I understand massage therapy is not a substitute for medical diagnosis or treatment (required)
  23. I have disclosed all relevant health information and will update the therapist if it changes (required)
  24. Signature (required)
  25. Date (required)

You can reword any of these, or add your own, after you create it.

An example of what you see when answers come in, with three replies
17 Aug, 19:27Bea Whitlockshe/her1995-08-21(206) 555-0182bea.w@example.com2026-08-19NiaTom Whitlock, brother(360) 555-014028 weeks pregnant, hips and lower back. Sleeping badly.Lower back, Hips and glutes, LegsAbdomen.LightPregnant, Varicose veins28 weeks, no complications. Varicose veins both calves.Prenatal vitaminsNone known5No, this is my firstYesYesYesYes2026-08-17
16 Aug, 14:40Ravi Menonhe/him1969-12-14(425) 555-0193r.menon@example.com2026-08-18CassLakshmi Menon, wife(425) 555-0117Lower back after a long flight. Sitting is worse than standing.Lower back, Hips and glutesStart medium and adjustHigh or low blood pressure, Taking blood thinnersBP controlled on ramipril. Apixaban after an AF diagnosis last year — cardiologist is fine with massage.Ramipril, apixabanNone known7Yes, occasionallyYesYesYesYes2026-08-16
16 Aug, 08:12Ingrid Halvorsenshe/her1981-05-09(206) 555-0128ingrid.h@example.com2026-08-17CassErik Halvorsen, husband(206) 555-0165Right shoulder, desk job. Worse by Thursday. Stretching helps for an hour.Neck, Shoulders, Upper backPlease avoid my feet.FirmNone of theseNoneNut oils6Yes, regularlyYesYesYesYes2026-08-16

Scroll sideways for the rest of the 25 answers, and press any heading to sort by it. In your own form you can search the answers as well, and download them as a spreadsheet at any time.

"Areas to avoid" is the most important box on the form

A client on the table, face down, with their head in a cradle, is in the worst possible position to say "not there". Asking beforehand — in a free box, with an explicit note that no explanation is needed — is the difference between a preference recorded and a boundary crossed.

It also catches things a checklist never would: a scar, a tattoo healing, an area that is tender for reasons the client does not want to discuss.

The contraindication list is genuinely clinical

Blood clots and a history of DVT, blood thinners, recent surgery, osteoporosis and active cancer treatment all change what is safe. Pregnancy changes positioning. Uncontrolled blood pressure changes pace and pressure. This is not a formality list.

Ask it as a checklist and give a free box underneath. "Recent surgery in the last six months" plus "knee replacement, March, cleared by my surgeon" is a usable answer; either half alone is not.

Pressure preference prevents most first-visit complaints

"Too light" and "too deep" are the two most common pieces of feedback after a first massage, and both are avoidable by asking. "Start medium and adjust" is the honest answer for most people and it gives the therapist an explicit mandate to check in.

The reason for the visit, in their words

Where it hurts, what makes it worse, and what has already been tried is three sentences that shape the whole hour. It is also the field that tells you whether the client is here for relaxation or for a specific problem, which are different appointments.

One link with the booking, not a clipboard at reception

This form takes four minutes to fill in properly and about ninety seconds to fill in badly on a clipboard while the therapist waits. Sending it with the appointment confirmation gets the four-minute version, and the answers arrive as a spreadsheet you can read before the client walks in.

If your clinic already has an intake form your insurer expects, upload that PDF instead — the questions are read off the document and the wording is unchanged.

Check your state board and your insurer

Record-keeping requirements, what must be disclosed, and how long intake records must be retained are set by state massage boards and by insurers, and they differ. This is a starting point.

Questions people ask

What should a massage therapy intake form include?

Contact details and an emergency contact, the reason for the visit, areas to work on and areas to avoid, pressure preference, a contraindication checklist covering pregnancy, blood pressure, clots and blood thinners, diabetes, osteoporosis, recent surgery, cancer treatment, skin conditions and recent injury, medications and allergies including oils, a current discomfort rating, and consent covering draping, the right to stop at any point, and that massage is not medical treatment.

What are the contraindications for massage?

Absolute or conditional contraindications commonly include current blood clots or a DVT history, uncontrolled blood pressure, active infection or open wounds in the area, recent surgery, severe osteoporosis, and some stages of cancer treatment. Pregnancy changes positioning rather than ruling massage out. Each needs a conversation, which is why the form asks as a checklist with a free box underneath.

Why does a massage intake form ask which areas to avoid?

Because a client already face down on the table is in the worst position to raise it. Asking in advance, and saying explicitly that no explanation is needed, records the boundary before it can be crossed.

Does a massage client need to fill in a new form every visit?

Most clinics take a full intake once and a short update each visit, because medications, injuries and pregnancy status change. Sending a link each time costs nothing, which makes updating practical.

Is this massage intake form free?

Yes. Download the PDF with no account and no email address, or send the online version with your booking confirmation.

Ready to send it out?

Every question above is already written. Make it a form, get your link, and send it. Reword anything first if your group asks it differently.

Free, no account needed to start, and the printable PDF stays one click away.

Already have your own version of this form?

You build nothing. Drop the PDF here, or photograph the printed copy, and the questions are read off it: no canvas, no dragging a box onto each field, no mapping step. The wording your organisation already approved stays exactly as it is, and you get a link that collects the answers back as a spreadsheet — and as the original document, filled in.

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