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Massage therapy health history form

A client's health history is information that a massage therapist needs in order to provide safe and effective massage treatment. A health history form is a tool that helps the therapist to collect this information. The form should include questions about the client's health history, current health status, and any medications or supplements that the client is taking. The form should also include a consent form that the client must sign before the massage session can begin.

Time to complete

3 minutes

Eligibility

The individual must be 18 years of age or above. The individual must not be suffering from any major health problem. The individual must not be suffering from any contagious or infectious disease. The individual must not be pregnant. The individual must not be suffering from any mental disability. The individual must not be under the influence of alcohol or any other intoxicating substance.

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Questions for Massage therapy health history form

1.

Do you have any physical ailments, injuries, or conditions that we should know about?

The answer should be a single choice:

Yes
No

2.

If so, please describe:

The answer should be a text input.

3.

Do you have any allergies or sensitivities?

The answer should be a single choice:

Yes
Np

4.

If so, please describe:

The answer should be a text input.

5.

Do you have any medical conditions or are taking any medications that we should know about?

The answer should be a single choice:

Yes
No

6.

If so, please describe:

The answer should be a text input.

7.

Do you have any mental or emotional conditions that we should know about?

The answer should be a single choice:

Yes
No

8.

If so, please describe:

The answer should be a text input.

9.

What is the primary reason you are seeking massage therapy at this time?

The answer should be a text input.

10.

What are your expectations from this massage therapy?

The answer should be a text input.

11.

What are your goals for massage therapy?

The answer should be a text input.

12.

What other health care providers (e.g., doctor, chiropractor, etc.) are you currently seeing for this reason?

The answer should be a text input.

13.

If you consent to get this massage done. Please sign below.

The answer should be a signature.

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Here are some FAQs and additional information
on Massage therapy health history form

Do I need to fill out a health history form?

Yes, all new clients are required to fill out a health history form prior to their first massage session. This helps the therapist understand your health history and any conditions that may impact the massage session.

How often do I need to update my health history form?

It is recommended that you update your health history form at least once per year, or more frequently if there are any changes to your health status.

What information do I need to provide on the health history form?

You will need to provide general information about your health, including any medical conditions, medications, and allergies. You will also need to disclose any areas of pain or discomfort.

Why is it important to disclose my health information to the therapist?

Disclosing your health information is important so that the therapist can tailor the massage session to your specific needs and avoid any potential harm.

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