Massage intake form: health history, preferences and a body chart that guides the session
A new massage client walks in with a lot you cannot see: a surgery last spring, a blood thinner, a habit of holding their breath under firm pressure. The intake form brings that out before the oil is open, and tells you how your client wants to feel.
This exact form is built into SlickChart: send it to your client's phone to fill in before the first visit, and their answers are waiting in their chart when they arrive.
Contact details, then what they are booking
My intake opens with the basics: contact details, an emergency contact, and how they heard about you. Two small questions save back and forth later: the best way to reach them and whether it is OK to text reminders.
Then your client checks every service they are booking: Swedish and relaxation, deep tissue, sports, prenatal, hot stone, cupping, lymphatic drainage, or chair and couples. A second list asks for the reasons today: relaxation, pain, stress, injury, sport, post-surgery or pregnancy. A check on "post-surgery" or "pregnancy" tells you which consent comes next.
Pressure and areas, in their own words
Pressure gets a simple scale from 1 very light to 5 very firm, plus "not sure yet." That last option matters, since first-timers often have no idea. Two open boxes follow: areas to focus on, and areas to avoid. "Avoid my feet" is as useful as "focus on my shoulders."
A massage history with no wrong answers
Ten quick yes or no questions cover whether they have had a professional massage before, get massage regularly, felt sore after one, bruise easily, have ticklish or sensitive areas, are comfortable lying face down, prefer to stay partly clothed, prefer quiet, prefer a warm table, and want their feet or scalp included. The form frames it kindly:
Your massage history: there are no wrong answers. This helps your therapist plan a session you will feel comfortable in.
Boxes for what they enjoyed in past massages, and what they did not, round it out, then a few lifestyle questions: desk work or on their feet, exercise, sleep, and stress this week on a 1 to 10 scale.
The health check
The form asks your client to answer every line and explains why: some answers mean a gentler session or a doctor's OK first, and answers stay confidential. Sixteen items:
- High or low blood pressure, a heart condition, blood clots or DVT now or past, blood thinners
- Diabetes or neuropathy, cancer now or in the past, osteoporosis
- Surgery in the past 6 months, injury in the past 3 months, pregnancy (with weeks)
- Epilepsy or seizures, a skin condition, rash or sunburn, varicose veins
- An implanted device such as a pacemaker, port or pump, kidney disease, and a fever, cold or contagious illness now
Medications, supplements and their physician's contact follow. A check is a reason to talk and maybe adjust, never a diagnosis. What a health condition means is for their doctor to say, and my massage draping and boundaries post covers the physician clearance form for when a doctor's OK is needed.
An allergy checklist covers nut oils such as almond or coconut, fragrance or essential oils, latex, lotions or creams, and wool or fabric softener. Two more questions ask about Botox or fillers in the past 2 weeks and a new tattoo in the past 4 weeks, so you know what to work around.
The acknowledgements and privacy line
Your client confirms their answers are true and they will tell you if their health changes. They will speak up if pressure, temperature or a technique feels uncomfortable. Massage is not a substitute for medical care, and the therapist does not diagnose or prescribe. They can stop at any time, and you may end the session if continuing is unsafe.
The privacy line says their information is kept confidential and never shared without written consent unless the law requires it. My form says records are kept 7 years; match that to your state.
The body chart and treatment plan
For clients with pain or a goal, a second form picks up where intake ends. The body chart asks your client to describe, front and back, where they feel pain (P), tension (T), numbness or tingling (N), and any area to avoid (X). It asks for the main concern, what makes it better or worse, and pain before and after on a 0 to 10 scale.
Goals are checkboxes: relaxation, less pain, mobility, stress relief, recovery, better sleep or prenatal comfort. You write the plan for sessions 1, 2 and 3, then check home care such as stretching, heat, ice or posture breaks. Your client signs that they reviewed the plan and understand results vary.
Questions to decide for your own practice
- Will every new client fill in the full intake, or only the body chart for pain-focused bookings?
- How often will returning clients update their health answers?
- What does your state board require? Record keeping and scope of practice vary by state, so check with yours. This post is not legal or medical advice.
For the next step after intake, see my deep tissue massage consent form post, or browse the full massage therapist forms collection.
Use this form with your clients
SlickChart has this exact massage intake and body chart built in for subscribers. The form goes to the client's phone to fill in before the visit, or they sign on your device at the table, and any health item they check is flagged for you. Aftercare lands in the client's own app, styled with your logo, and it all works alongside the Square account you already have. If that would save you paperwork, try SlickChart.
Prefer paper? The printable massage therapist set, with this intake, the body chart and the treatment plan, is in my Etsy shop, ready to print or edit in free Canva.