Clients usually decide whether they will return to a massage therapist after the initial consultation. A big part of that decision depends on how well the therapist understands their concerns, preferences, and treatment goals. A massage client intake form can help gather this important information before the session begins.
This editable massage client intake form template from WordLayouts is suitable for massage therapists, wellness centers, and spa professionals. Instead of creating your own form from the ground up, you can customize the template to match your practice and workflow. It is available for both digital and printed use.
What Is a Massage Client Intake Form?
A massage client intake form is a document that collects clients’ information to understand their health conditions, physical needs, and preferences to provide safe, effective, and personalized massage therapy.
According to the American Massage Therapy Association (AMTA), a massage intake form is a crucial part of the overall client communication strategy. It’s a pre-session document that lets therapists and masseuses know the prospective client’s current health information to help ensure the safety and satisfaction of the client.
It mostly includes information such as:
- Personal details
- Medical history
- Injuries
- Area of pain or tension
- Preferences for massage techniques
- Consent
Overall, it is an official pre-session document that helps therapists create a record for future appointments as well.
Massage therapy: Health conditions and contraindications
This template is designed to do more than simply record client information. It helps massage therapists understand a client’s physical condition, comfort preferences, treatment goals, and any factors that influence how the massage session is performed.
The template provides an easy-to-fill section for the client to disclose information about their health condition in detail. The health questionnaire helps identify contraindications, which are conditions or circumstances that may affect whether massage therapy can be performed safely. These are generally classified as absolute, local, and relative contraindications.
Absolute contraindications refer to conditions where massage should be avoided entirely because it could pose a serious risk to the client’s health. Examples include infectious diseases, acute injury/trauma, blood-clot risk, etc.
Local contraindications specifically refer to areas of the body where massage should be avoided due to issues such as skin problems and bruises. While relative contraindications are conditions where massage may still be possible, but the therapist may need to modify techniques, pressure, or positioning, or avoid certain areas. Examples include pregnancy, recent injuries, and high blood pressure.
By identifying these conditions in advance, therapists can adapt treatment plans to improve safety, comfort, and effectiveness.
What Is Included in This Template?
The template follows a questionnaire model and includes fields and checkboxes to make it easy to use. Mainly, it’s divided into six sections:
- Client details
- Health details
- Massage details
- Consent & Acknowledgment
- Confidentiality and Data Protection
- Survey
Client details
The form starts by recording the client’s status, i.e., new client or existing client, and the date for record-keeping purposes. Then it records client details such as the client’s name, date of birth, age, contact information including phone number, email, address, etc.
The template also provides space for an alternate contact and their relationship with them and their phone number. This can be useful if you are unable to reach the client directly or need an emergency point of contact.
Health details
Next, the template includes a detailed health questionnaire. Here, the client can mention any kind of general health issues, medications, allergies, doctor care, medical conditions, or recent injuries.
Initially, the form provides four options (excellent, good, fair, and poor) to rate general health and asks for a brief description if the client is taking any medications.
Next, it asks about any allergies, recent facial, dermatological, or skin care treatments in the past 30 days, or if the client is still under a doctor’s care. These details can help you better understand the client’s overall health before planning the session.
Following that, the section includes a detailed list with checkboxes to know whether the client has or has had any health conditions. The list includes general issues such as areas of swelling, back/neck problems, bleeding disorders, blood clots, bruising easily, headaches, and more serious conditions like cancer, autoimmune disorders, stroke, kidney disease, osteoporosis, heart issues, etc. It also includes an “other” option with space here where the client can write any other health condition that’s not already part of the list.
It further asks for details about whether the client has any broken areas (rash, wound, etc), joint replacement surgery, any recent injuries, or has undergone any medical procedure in the past 2 years. In all these questions, we have added two options: yes and no, along with fields so that the client can add details, as it can be quite significant in determining the kind of treatment. For example, a therapist may need to avoid applying pressure near a healing wound or use modified techniques around a replaced knee or hip joint to ensure the session is both safe and comfortable.
Massage details
In the next section, the template focuses on the client’s massage history, current concerns, and treatment preferences. It includes things like whether the client has received professional massage therapy before, and if they have, the form provides space to note when their most recent session took place and the reason for taking therapy.
Next, the template inquires about the client’s reason for the current visit. It provides several common options such as relaxation, stress relief, pain management, injury recovery, or other purposes so that you can tailor the session to meet their specific needs.
One of the most practical features of this section is the body diagram, where clients can mark areas of pain, tightness, or discomfort. The form also asks how frequently these issues occur and provides options to select from, such as occasionally, frequently, or constantly.
The template also allows clients to indicate their preferred pressure level, ranging from light to deep pressure, to create a better overall experience.
Additionally, clients can specify areas they would like the therapist to avoid during the session. For example, areas of recent injuries, sensitivity, or personal comfort preferences.
Lastly, the form gives options for preferred massage style, such as Swedish, deep tissue, hot stone, or aromatherapy massage. For first-time clients or those who are unsure, the template also includes an “Unsure / First Time” option.
There is also an additional notes section that allows clients to share any other information they believe may be relevant.
Consent & acknowledgment
To save the business from liabilities, the fourth part of the template includes a consent and acknowledgment statement with a field for the client’s signature. It confirms that:
- The information provided by the client is true and complete.
- Massage therapy is intended for relaxation and therapeutic purposes and is not a substitute for medical care.
- The therapist does not diagnose medical conditions, prescribe medication, or perform spinal manipulations.
- The client agrees to inform the therapist of any changes to their health or medical condition.
- The client releases the therapist and facility from liability for any discomfort/injury after massage therapy, except in cases of proven negligence or misconduct.
Survey
The template also includes a short survey section that helps you understand which marketing channels are bringing in new clients and whether they would like to receive promotional emails.
Confidentiality & data protection
The last part of the template is confidentiality and data protection. This section is designed to support privacy and record-handling practices commonly associated with the Health Insurance Portability and Accountability Act (HIPAA). It ensures the client’s privacy is respected and their information is protected securely and is only accessible by authorized individuals. The section also includes a field where the practice can specify how long client records will be securely retained before they are destroyed. This means that after the selected time period, the information will be destroyed.
Here are some other tips to make your form HIPAA compliant.
How to Make Your Massage Client Intake Form HIPAA-Compliant?
Health-related information is quite personal, and everyone wants to keep it private, especially if your practice is legally required to comply with HIPAA. And even if your practice isn’t bound to comply with HIPAA, following recognized privacy and security practices can help protect your clients’ information and build trust:
Collect necessary information
As per HIPAA 45 CFR 164.502(b), 164.514(d), covered entities should limit the use, disclosure, and collection of protected information.
In your form, only ask for information that is genuinely required to provide safe therapy. For example, medical conditions, allergies to oils or lotions, injuries or surgeries, and current medications, if relevant.
Store records securely
Client intake forms contain highly sensitive personal information, which is why they should be protected against unauthorized access and should have limited access. For example, use password-protected practice management software or encrypt digital records for privacy.
These practices help protect confidential information and reduce the risk of accidental disclosure.
Obtain consent
According to HIPAA, written authorization is generally required for many disclosures outside routine treatment, payment, or healthcare operations.
If your workflow also involves obtaining a client’s medical documentation from healthcare providers, you can pair this template with our Medical Records Request Letter Under HIPAA.
Set Up a Massage Client Intake Form
- Download the template in your preferred format. It’s available in Microsoft Word and Google Docs formats.
- Customize the file according to your business branding requirements. Add your center’s logo, business name, and contact information, or if you are a freelance practitioner, add your name and contact details.
Also, customize the questionnaire according to your business requirements. For example, a sports massage therapist may ask about athletic activities, recent injuries, training schedules, and recovery goals. In contrast, a prenatal massage therapist should include questions about the stage of pregnancy, any high-risk conditions, the client’s healthcare provider’s recommendations, and pregnancy-related discomforts or complications. - Choose a paper or digital workflow. If you want to use it manually, simply edit the file and print copies. But if you want to use it digitally on a tablet or client portals, then convert the customized file into a fillable PDF.
- Now you can share the form with your clients. New clients complete all sections, while existing clients use the form to confirm or update previously provided information.
Who Can Use This Template?
This template can be used by:
- Licensed massage therapists
- Independent massage practitioners
- Day spas
- Wellness centers
- Holistic therapy clinics
- Sports recovery clinics
- Mobile massage businesses
- Chiropractic clinics offering massage
- Rehabilitation centers
- Resort spas
Conclusion
A well-organized intake process helps both the therapist and the client start each session with a better understanding of comfort levels and individual needs. Having important health information in one place can make appointments more efficient and help create a more personalized experience for returning clients.
This template is flexible and can be adapted to fit your workflow and the services you provide. Available in Microsoft Word and Google Docs formats, it can be completed digitally or printed for in-person appointments. Simply customize it to match your practice and start building a more client-focused intake process.
