# Massage Intake Form Template

> A free massage intake form for therapists and spas. New clients share focus areas, pressure, health notes and consent before the first session.

A massage client intake form that covers contact details, what brings them in, areas to focus on or avoid, pressure, health conditions and medications, with a signature to confirm consent.

Canonical: https://reuily.com/templates/massage-intake-form
Use this template: https://reuily.com/form/from-template/massage-intake-form
Collections: Requests & Intake, Beauty & Wellness, Holistic Wellness
Last updated: 2026-10-24

## Questions

- Question 1: What's your full name? (Short Text, required)
- Question 2: What's your email address? (Email, required)
- Question 3: What's your phone number? (Phone, required)
- Question 4: Have you had a professional massage before? (Yes / No, required)
- Question 5: What brings you in today? (Single Choice, required). Options: Relaxation; Pain or tension; Sports recovery; Pregnancy; Something else
- Question 6: Which areas should we focus on? (Multiple Choice, optional). Options: Neck and shoulders; Upper back; Lower back; Legs; Feet; Arms and hands
- Question 7: Is there anywhere we should avoid? (Short Text, optional)
- Question 8: What pressure do you prefer? (Single Choice, required). Options: Light; Medium; Firm; Not sure
- Question 9: Do any of these apply to you? (Multiple Choice, optional). Options: Pregnant; High blood pressure; Recent surgery or injury; Blood clots; Skin condition; None of these
- Question 10: What medications do you take? (Long Text, optional)
- Agreement: Massage consent, accepted with "I agree" (full text below)
- Question 11: Sign to confirm your answers and consent (Signature, required)

Signing records the signer's consent, email, IP address, browser and signing time, and each signer can download a signed PDF copy.

## Massage consent

Please read this before you sign.

This consent is between **[Business name]** (the "Therapist") and the client named in this form.

1. **Accurate answers.** I have answered the health questions truthfully and will tell the Therapist about any change before a session.
2. **Not medical care.** Massage is not a substitute for medical diagnosis or treatment. I will check with a doctor if I am unsure massage is safe for me.
3. **Comfort.** I can ask the Therapist to change pressure, skip an area or stop the session at any time.
4. **Draping.** I will be draped at all times except the area being worked on.
5. **Conduct.** The Therapist may end a session if there is any inappropriate behavior.
6. **Cancellations.** Sessions cancelled with less than **[number]** hours notice may be charged **[fee]**.

By signing below, I confirm that I have read this consent and agree to it.

## Common uses

- Massage therapists
- Day spas and wellness studios
- Sports and mobile massage

## Key features

- Focus areas and pressure
- Health conditions and medications
- Signed consent

## Frequently asked questions

### What should a massage intake form ask?

Contact details, what brings the client in, areas to focus on or avoid, pressure preference, health conditions such as pregnancy or recent surgery, medications and consent.

### Can clients mark areas to avoid?

Yes. Clients list injuries or places they'd rather not be touched, so your therapist knows before the session starts.

### Can clients fill it in before they arrive?

Yes. Send the link with the booking confirmation so the therapist reads it before the session.