Massage Intake Form

Full Name*

Date of Birth*

Email Address*

Phone Number*

Current Health Conditions

Areas of Pain or Tension*

Pressure Preference*

Light

Medium

Firm

Deep

Are you currently pregnant?*

Have you had massage therapy before?*

What is this form?

A comprehensive intake form for massage therapy clients. Collects health history, areas of pain, and treatment preferences for personalized care.

Licensed massage therapists, chiropractic offices, and physical therapy clinics.