Prenatal massage intake form

This is a form that is used to record information about a client's prenatal massage. This form can be used to record client information such as:- Client's name- Contact information- Pregnancy history- Massage goals- Health concerns

2 minutes to complete


The eligibility criteria for the prenatal massage intake form are- the person who is willing to get a prenatal massage must be pregnant, the person must be 18 years old, and the person must not have any type of medical complications like diabetes or high blood pressure, the person must not have any type of infection in the body.


Questions for Prenatal massage intake form




The answer should be a text input.


The answer should be a text input.

Phone number

The answer should be a phone number.


The answer should be an email input.

Pregnancy Due date

The answer should be a date input.

Primary care physician

The answer should be a text input.

Are you comfortable with any gender of your massage therapist?

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

Do you have any areas of pain or discomfort?

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

Do you have any allergies or sensitivities?

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

Are you experiencing any nausea or vomiting?

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

Do you have any medical conditions?

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

Do you take any medication?

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

Do you have any questions or concerns?

The answer should be a text input.

Forms Similar to Prenatal massage intake form

  • Client information form
  • Pregnancy history form
  • Obstetrician/gynaecologist (OB/GYN) information form
  • Insurance information form
  • Medical release form
  • Payment information form

Here are some FAQs and additional information
Prenatal massage intake form

What is a prenatal massage?

A massage is given to a pregnant woman to help alleviate discomforts associated with pregnancy.

What are the benefits of a prenatal massage?

Prenatal massage has been shown to be helpful in reducing anxiety, relieving muscle aches and joint pains, and improving labor outcomes and newborn health.

What are the contraindications for a prenatal massage?

Pregnant women should avoid massage if they have a history of blood clots, are at risk for premature labor, have high blood pressure, or are experiencing any other serious health condition.

What can I expect during a prenatal massage?

A prenatal massage is typically a full-body massage, though the focus will be on areas of the body that are most affected by a pregnancy, such as the back, neck, hips, and legs. The massage therapist will use pillows and other props to help you get into a comfortable position.

How often should I get a prenatal massage?

There is no one-size-fits-all answer to this question. Some women benefit from weekly or bi-weekly massages, while others find that massage every month or two is sufficient.

How will I know if a prenatal massage is right for me?

You should always consult with your healthcare provider before beginning any new massage therapy regimen. If you have any concerns or questions about whether or not a prenatal massage is right for you, your healthcare provider should be able to give you guidance.

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