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Customizable massage therapy intake form

A customizable massage therapy intake form can be used to collect important client information prior to a massage therapy session. This form can be customized to include any information that you feel is important to collect from your clients.

Time to complete

5 minutes

Eligibility

Any individual who is willing to get massage therapy must be 18 years or above.

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Questions for Customizable massage therapy intake form

1.

How did you hear about our office?

The answer should be a text input.
2.

What are the reasons for seeking massage therapy at this time?

The answer should be a text input.
3.

Do you have any current or past health conditions that we should be aware of?

The answer should be a text input.
4.

Do you have any current or past injuries that we should be aware of?

The answer should be a text input.
5.

Do you have any current or past medications that we should be aware of?

The answer should be a text input.
6.

What are your current stress levels?

The answer should be a text input.
7.

What are your current pain levels?

The answer should be a text input.
8.

What is your current sleep quality?

The answer should be a text input.
9.

What is your current diet like?

The answer should be a text input.
10.

What is your current level of physical activity?

The answer should be a text input.
11.

What are your current mental health status?

The answer should be a text input.
12.

What is your name?

The answer should be a text input.
13.

What is your phone number?

The answer should be a phone number.
14.

What is your email address?

The answer should be an email input.
15.

What is your date of birth?

The answer should be a date input.
16.

Are you pregnant?

The answer should be a single choice:
  1. Yes
  2. No
17.

Do you have any surgical scars?

The answer should be a text input.
18.

Do you have any other skin conditions?

The answer should be a text input.
19.

What is your smoking status?

The answer should be a text input.
20.

What is your alcohol consumption status?

The answer should be a text input.
21.

What is your caffeine consumption status?

The answer should be a text input.
22.

What is your drug use status?

The answer should be a text input.
23.

What is your sexual activity status?

The answer should be a text input.

Similar Ideas

  • Initial Massage Therapy Intake Form
  • New Client Massage Therapy Intake Form
  • Client Massage Therapy Intake Form

Here are some FAQs and additional information
on Customizable massage therapy intake form

What are the benefits of massage therapy?

There are many benefits to massage therapy, including reducing stress, improving circulation, and relieving pain.

How often should I get a massage?

Most people benefit from getting a massage once or twice a week. However, this can vary depending on your individual needs.

How long will a massage session last?

A typical massage session lasts for 60-90 minutes.

How should I prepare for a massage?

It is generally recommended that you drink plenty of water before and after a massage to help flush out toxins from your body. Other than that, just relax and enjoy your massage!

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