Free template

Massage Intake Form Template: free, printable, with consent and health history

Print this form, or read the field guide and build your own. An intake form has one job on the day and a different job three years later: on the day it tells you what to ask about before you start, and later it is the record showing that you asked at all.

Print this page to get the blank form on its own: everything else is hidden on paper.

Client intake and health history

Name Date of birth Phone Email Emergency contact Date

What brings you in today?

Current medications

Injuries, surgeries or conditions, with rough dates

Please tick anything that applies

Recent surgery, fracture or acute injury
Blood-thinning or blood-pressure medication
Diabetes or any loss of sensation
Skin conditions, open wounds or recent tattoos
Pregnancy, now or in the last six weeks
Anything that makes lying face down uncomfortable

Areas to avoid, and pressure preference

Consent

I confirm the information above is accurate to the best of my knowledge, and I agree to receive massage therapy. I understand I may ask questions at any time, and that I may decline or stop any part of the session. I will tell my therapist if my health changes.

Why ask for a health history at all?

Because you cannot ask a useful follow-up question about something you were never told. The history is not there so you can rule a client in or out on paper. It is there so that when someone mentions a recent surgery, a blood-thinning medication or an area that has been painful for months, you notice it before the session rather than halfway through, and can ask the one further question that changes what you do or whether you refer the client on.

What each field is actually for

Contact details and date of birth: identify the file, and flag when a client is a minor, which changes both consent and how long the record must be kept.
Reason for the visit today: sets the session, and gives you the client’s own words to quote in the Subjective field of the note.
Current medications: some affect bruising, blood pressure, sensation or how a client responds to pressure. You are not assessing the medication, you are noticing that it is there.
Injuries and surgeries, with dates: recent is different from old, and a date lets you ask the follow-up rather than guessing.
Ongoing conditions the client wants you to know about: worded as an open invitation, because a checklist of named conditions invites people to tick nothing.
Pregnancy: changes positioning, so it needs to be asked directly rather than inferred.
Areas to avoid: the single most useful line on the form, and the one clients most often fill in unprompted.
Pressure preference: cheap to ask, and it prevents the most common first-session complaint.
How they heard about you: not clinical, but it is the only marketing data a solo practice reliably gets.

Consent belongs on the form, and in the note

A signature at intake records that the client agreed to treatment and understood what it involves. It does not cover everything forever. When a session calls for work that warrants a specific conversation, such as an area a client has not been worked on before, record that conversation in the note for that session. Consent that lives only on a form signed two years ago is thinner than it looks, and a one-line record in the day’s note is what makes it real.

Update it, do not overwrite it

Health histories go stale: medications change, injuries happen, pregnancies begin and end. Ask returning clients to confirm or update at least once a year, and keep the old version rather than writing over it. What was true when you treated someone in 2024 is the record that matters if anyone asks about a 2024 session, and a form that only ever shows today’s answers cannot tell you what you knew back then.

Handle the completed form like the clinical record it is

A finished intake form holds health information a client handed you in confidence. Store it somewhere only you can reach, whether that is a locked cabinet or an encrypted device such as the SOAP notes app, and do not leave completed forms on a clipboard in a shared space. How long you must keep it varies by state, and several states count from the end of the therapeutic relationship rather than the last session, so check the rule that applies to you on our record retention by state page. For the session notes themselves, there is a free massage SOAP note template.

FAQ

Common questions

What should a massage intake form include?

Contact details and date of birth, the reason for today’s visit, current medications, injuries and surgeries with dates, any ongoing conditions the client wants you to know about, pregnancy status, areas to avoid, pressure preference, and a dated consent signature. Anything beyond that should earn its place: a form long enough to feel like paperwork gets filled in carelessly, which defeats the point.

Do I need a new intake form for every session?

No. Take a full history at the first visit, then confirm or update it periodically, at least annually and any time a client mentions something new. What matters is that updates are added as new versions rather than written over the old ones, so the file still shows what you knew at the time of each past session.

Is a signature on the intake form enough consent?

It is the baseline, not the whole of it. A signature at intake records agreement to treatment in general. Where a particular session involves work that warrants a specific conversation, note that conversation in that day’s record. Consent is an ongoing conversation with a paper trail, not a one-time signature.

Can I keep intake forms on my phone instead of on paper?

Yes, and many therapists find it easier to keep secure than a folder of paper. What matters is that the information is protected and that you can produce it later: encrypted storage, access only by you, and a way to export or print a client’s file if it is ever needed. Paper in a locked cabinet and an encrypted device both satisfy that; a spreadsheet synced to an open cloud folder does not.

What if a client refuses to fill in part of the form?

Record that they declined, and carry on with the conversation. A blank field is ambiguous later, while "declined to list medications" is a fact you documented. It also tells you to ask more carefully in person, since a refusal is usually about privacy or discomfort rather than about having nothing to say.