A massage client intake form is the health history and consent sheet a client fills in before their first massage, so the therapist knows what to avoid, what to focus on and how the client wants the session to go. This free massage therapy intake form is written for independent therapists and small studios, and it includes the parts clients tend to skip past but therapists care about most: contraindications, pressure, draping and the client’s right to stop.

Why is a massage intake form different from a general patient intake?

Massage has its own risks and its own consent questions, so a generic medical form misses things. A doctor’s intake asks about insurance and family history. A massage client intake form needs to know about blood clots, recent surgery, pregnancy, skin conditions, allergies to oils, and whether the client wants firm pressure on their back but nothing on their feet.

Our general patient intake form suits PT or chiropractic offices that bill insurance. If you run classes or offer something physically demanding, like assisted stretching, a separate release of liability waiver may also make sense, though it won’t replace a careful intake.

What should the health history section cover?

It should cover the conditions that change what you’ll do on the table. Our template asks about:

  • The reason for the visit and where it hurts, marked on a front and back body outline if you like
  • Current medications, since blood thinners and some pain medications change how you work
  • Allergies, including to nuts, oils, lotions and fragrances
  • Recent surgeries, injuries or fractures, with dates
  • A checklist of conditions: blood clots or history of DVT, varicose veins, high or low blood pressure, heart conditions, diabetes, cancer treatment, pregnancy (and how far along), skin conditions or open wounds, recent fever or contagious illness, numbness, joint replacements, osteoporosis
  • Whether the client is under a doctor’s or other provider’s care, and for what

It also asks the client to tell you if anything changes before a future session. The form is only as good as the day it was filled in.

A quick example. Hypothetically, Marcus books a 60-minute deep tissue session for his calves before a half marathon. On the form he mentions he started a blood thinner last month after a clot. That single checkbox changes the whole session, and a good therapist will want clearance from his doctor first. That’s why the history comes before the preferences.

Pressure and focus. Light, medium, firm, or “ask me during the session.” Areas to focus on, and areas to avoid entirely. Some clients don’t want their face, feet, glutes or abdomen touched, and they shouldn’t have to say it out loud on the table.

Draping. A short statement of how you drape and what stays covered. Board rules on this vary. Missouri’s standards of practice, for example, require draping of the gluteal cleft and genitals for everyone and the breasts for women. Put your state’s rule, and your own practice, on the form in plain words.

The right to stop. The client can ask you to change pressure, skip an area, or end the session at any time. Missouri’s rule requires therapists to modify or end the massage at the client’s request regardless of prior consent. That’s good practice everywhere.

Minors. If you see clients under 18, the template has a parent or guardian consent section, a question about whether the parent will be in the room, and a signature line for the parent. Don’t start a session with a minor until it’s signed.

What records does your state board expect?

Check your board’s rules before you finalize the form, because some spell out what a client record must contain. Missouri’s rules, for instance, list the purpose of the visit including any pain, allergies, preexisting conditions, recent surgeries and current medication, whether the client is under a health professional’s care, the date, type and length of service, an outcome assessment, a signed and dated consent to treatment, and the licensee’s signature and date. That’s why our template has a therapist signature line and a short session notes box.

HIPAA is a separate question. HHS says a health care provider is a covered entity only if it transmits health information electronically in connection with a standard transaction, like billing insurance electronically. A cash-only studio may not be covered. If yours is, whatever tool stores completed forms needs a business associate agreement. SignWren is not set up to handle HIPAA-covered data and does not sign BAAs.

How do you use the intake form and get it signed?

  1. Add your business name, license number and cancellation policy at the top.
  2. Rewrite the draping paragraph to match your state’s rule and how you work.
  3. Send the form ahead of the first visit so the client can look up medication names at home.
  4. Read it before the client is on the table, and ask follow-up questions about anything checked.
  5. Both of you sign. Update it at least once a year or whenever the client’s health changes.

Federal law says a contract or record can’t be denied legal effect just because it’s electronic, so e-signing an intake form is generally fine. For a cash-only practice, download it, fill in the blanks, and send it with whatever e-signature tool you like. For more on validity, see are electronic signatures legally binding.

This template is general information, not legal or medical advice. For your practice, check your state massage board’s rules and talk to a lawyer licensed where you work.