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Massage Therapy Intake Form
Health history, focus areas and pressure preference for massage therapists
intake · 12 fieldsFull Name*
Enter full name...
Email*
Enter email...
Phone*
Enter phone...
Date of Birth*
mm/dd/yyyy
Have you had a professional massage before?*
Yes
No
Areas to focus on
Neck
Shoulders
Upper back
Lower back
Legs
Feet
Full body
Areas to avoid
Enter areas to avoid...
Preferred Pressure*
Light
Medium
Firm
Do any of these apply to you?
Pregnancy
High blood pressure
Recent surgery or injury
Skin condition
Varicose veins
None
Current Medications
Type your answer...
Consent*
I understand massage is not a substitute for medical care
Signature*
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