Prenatal massage consent form: positioning, warning signs and the pregnancy health check
Prenatal massage is one of the kindest services on a massage menu, and one where the paperwork earns its keep. Your client's body changes week to week. A prenatal consent form explains how the session is adapted and makes the warning signs clear before anyone lies down.
This exact form is built into SlickChart: send it to your client's phone to sign before their session, and the prenatal aftercare goes home with them.
Start with who is caring for the pregnancy
Right after name and therapist, my form asks for weeks pregnant and due date, their prenatal care provider, and that provider's phone. Those lines turn "I should check" into a call you can make.
Explain the adapted session
The "about this service" box describes gentle massage adapted for pregnancy, with your client on their side or semi-reclined on pillows. It runs about 60 minutes at light to moderate pressure, and breaks or position changes are fine anytime. Ease often lasts a day or two, and many clients book every 2 to 4 weeks as pregnancy goes on.
Today's session is a checkbox: side-lying, semi-reclined with a left tilt, postpartum, or clearance on file.
The possible effects and risks
The list stays practical:
- Mild tenderness in the back or hips for a day or two
- Feeling faint lying flat, so that position is avoided
- A skin reaction to oil or lotion, with nut-free on request
- Lightheadedness when sitting up or changing position
- Heartburn or nausea in some positions
- Leg cramps, which your client tells you about so you can adjust right away
The box ends by saying massage does not replace prenatal care and the therapist does not diagnose or treat conditions.
A pregnancy health check
Twelve items, specific to pregnancy:
- High blood pressure or pre-eclampsia, gestational diabetes
- Bleeding this pregnancy, placenta previa or abruption
- A heart or kidney condition, twins or multiples
- Severe swelling or headaches, a preterm labor history
- Blood thinners or other medications, a blood clot or clotting disorder
- Varicose veins, and a nut or fragrance allergy
A box asks for more about anything checked. What a condition means for massage is for their prenatal provider to say, which is why the clearance line below matters. My massage draping consent form post covers the physician clearance form I use for a high-risk pregnancy.
The acknowledgements
These lines carry the safety rules:
- Your client has shared their health and pregnancy history and will tell you about changes at each visit.
- They are under a prenatal provider's care, and if the pregnancy is high-risk, they bring written clearance first.
- They will not lie flat on their back after about 20 weeks, and will say if any position is uncomfortable.
- They will speak up right away about dizziness, nausea, cramping, pain or anything that does not feel right.
- Leg pressure stays light, with no deep abdominal work, and they can change pressure or stop anytime.
- The abdomen and glutes are worked only with their OK, which they can withdraw.
One line protects both of you and is worth quoting:
You'll stop and refer me to my provider for warning signs such as bleeding, contractions or leaking fluid.
The signature covers prenatal massage today and at future visits this pregnancy.
Aftercare from the table to bedtime
My prenatal guide follows the rest of the day:
- Getting up: roll to the side, push up slowly and sit a moment before standing. No jumping up, and no driving if dizzy.
- First 24 hours: rest, sip water, have a snack. A warm, not hot, shower is lovely, but skip hot tubs, saunas, very hot baths and strenuous activity.
- Tonight: sleep on the side with a pillow between the knees and under the bump, and avoid lying flat on the back for long stretches after about 20 weeks.
- Between visits: gentle walks and stretches their provider approves, and rebooking in 2 to 4 weeks. No deep rubbing or massagers on the calves or inner legs.
It also asks your client to mention their massage at prenatal visits and to tell you about any new diagnosis. Postpartum massage is welcome when they feel ready, and after a C-section the guide says to wait for their provider's OK, usually around 6 weeks.
The call-your-provider list covers vaginal bleeding or fluid leaking, a severe headache or vision changes, pain, warmth or swelling in one calf, regular contractions or cramping, sudden swelling of the face or hands, and the baby moving less than usual. Chest pain, trouble breathing or fainting means calling 911.
Questions to decide for your own practice
- Will you ask for written clearance only for a high-risk pregnancy, or for other checked items too?
- How will you record the position you used and anything you adjusted, so the next visit starts from there?
- What does your state board require? Consent rules and scope of practice vary by state, so check with yours. This post is not legal or medical advice.
New clients fill in an intake first; see my massage intake form post, or browse the full massage therapist forms collection.
Use this form with your clients
SlickChart has this exact prenatal massage consent and aftercare built in for subscribers. The form goes to the client's phone to sign before the visit, or they sign on your device at the table, and any contraindication they check is flagged for you. The 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 prenatal consent, the protocol and the aftercare, is in my Etsy shop, ready to print or edit in free Canva.