Please complete this form before your massage so we can tailor your session.
Healthcare template · 14 fields (9 required) · ~3 min for respondents to complete · Free plan · No credit card · Fully customizable
Set up your massage intake form template
Please complete this form before your massage so we can tailor your session.
Match the massage types and session lengths to your menu. Review health conditions before the session and follow up on anything that needs a doctor's clearance. Use a HIPAA-appropriate setup if required.
The form separates phone number, date of birth, have you had a professional massage before?, type of massage into labeled questions. Review the choices and required fields for your organization before sharing it.
Best practices
Match the massage types and session lengths to your menu. Review health conditions before the session and follow up on anything that needs a doctor's clearance. Use a HIPAA-appropriate setup if required.
Customize the phone number and date of birth questions to match your records and terminology.
Name the team that reviews responses and explain what happens after submission. A requested date, service or approval is not automatically confirmed.
Ask only for information needed for this step. Arrange any sensitive supporting documents through an appropriate private process.
Every field, explained
Your full name (Name, required)
Email address (Email, required)
Phone number (Phone, required)
Date of birth (Date, required)
Have you had a professional massage before? (Single choice, required)
Type of massage (Dropdown, required)
Session length (Single choice, required)
Areas to focus on (Multiple choice)
Areas to avoid (optional) (Multiple choice)
Preferred pressure (Single choice, required)
Injuries, health conditions or surgeries we should know about (optional) (Long text)
Are you currently pregnant? (Single choice)
Allergies, including oils or lotions (optional) (Short text)
Client signature (Signature, required) — I confirm the information above is accurate and will tell my therapist about any changes.
Frequently asked questions
What does this massage intake form template template collect?
Alongside contact details, it asks for phone number, date of birth, have you had a professional massage before?, type of massage, session length, areas to focus on, areas to avoid (optional), preferred pressure, injuries, health conditions or surgeries we should know about (optional), are you currently pregnant?, allergies, including oils or lotions (optional), client signature. You can rename questions, change choices and remove fields that your workflow does not need.
How should I use this massage intake form template form?
Match the massage types and session lengths to your menu. Review health conditions before the session and follow up on anything that needs a doctor's clearance. Use a HIPAA-appropriate setup if required.
Can I customize the acknowledgment and signature fields?
Yes. Provide your complete reviewed instructions or terms before collecting signatures. The signature field records input; it does not verify identity or guarantee legal effect. You can edit the form and print a copy.