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Free TemplateMassage

Massage Intake Form

Comprehensive intake form for massage therapy clients. Collects health history, pain areas, pressure preferences, and treatment goals.

Last updated: April 2026

Researched by the CheckinPulse Research Team

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Use This Form Digitally

Paper forms work, but digital forms work better. Here is what you get when you use this template on CheckinPulse:

  • Clients fill out on their phone (no app needed)

    Scan a QR code or tap a link — works on any device

  • E-signatures with legal timestamp

    IP address, timestamp, and audit trail on every signature — valid in all 50 states under the E-SIGN Act

  • Submissions go straight to your dashboard

    No more clipboards, filing cabinets, or illegible handwriting

  • PDF waivers stored for 7 years

    Encrypted, searchable, and accessible anytime on paid plans

Use this form digitally — free

Form Preview

This is what your clients will fill out. 20 fields, mobile-friendly.

Massage Intake Form

All fields marked with * are required

Jane Doe
jane@email.com
(555) 123-4567
Date
Text
Text
Phone
Helps identify postural patterns
Google
Pain relief
Neck, lower back, shoulders, etc.
1
Less than a week
Light
High/low blood pressure, diabetes, heart disease, cancer, blood clots, skin conditions, recent surgery...
Yes
Text
Yes — regularly
Injuries, sensitive areas, personal preference...
Submit Form

Legal References

E-SIGN Act (15 U.S.C. ch. 96) — Congress.gov

The federal law that makes electronic signatures on consent forms and waivers legally equivalent to handwritten signatures in all 50 US states.

Frequently Asked Questions

An intake form helps the therapist identify contraindications (conditions where massage could cause harm), tailor the session to your specific needs, and document your health history. Conditions like blood clots, recent surgery, or certain medications can make massage dangerous without modifications.

The big ones: blood clots or DVT (massage can dislodge a clot), recent surgery, heart conditions, high blood pressure, cancer, diabetes (affects sensation), skin infections, osteoporosis, and pregnancy. Each of these requires the therapist to modify their approach or sometimes decline the session.

Best practice is a full update every 12 months, with a quick verbal check-in at each visit. Medications change, new conditions develop, and preferences evolve. Digital intake forms make updates easy — clients can review and confirm their info from their phone before each appointment.

No. An intake form collects health history and preferences. A consent form documents that the client agrees to receive treatment and understands the risks. Most massage practices use both. Some combine them into one document, but they serve different legal purposes.

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