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Massage Therapy Intake Form
Intake

Massage Therapy Intake Form

1 page•17 fields
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Massage Therapy Intake Form

Massage Therapy Intake Form

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Full Name
Jane Martinez
Date of Birth
03/15/1985
Contact Information (Phone or Email)
(555) 867-5309
Emergency Contact (Name and Phone Number)
Jane Martinez
Have you had a professional massage before?
Select an option...
What is the primary reason for today's massage? (e.g., relaxation, pain relief, injury recovery)
Enter details here...
Are there any specific areas of the body you'd like us to focus on?
Enter details here...
Please indicate any areas of the body you would like us to avoid
Enter details here...
Do you have any of the following health conditions? (Check all that apply)
High Blood Pressure
Heart Conditions
Diabetes
Arthritis
Recent Injuries
Chronic Pain
Skin Conditions
Allergies
Pregnancy
Other (please specify)
If you selected 'Other', please specify
Enter details here...
Are you currently taking any medications?
Select an option...
If yes, please list your medications
Enter details here...
Do you have any allergies (e.g., lotions, oils, essential oils)?
Enter details here...
Preferred pressure level for the massage
Select an option...
Additional comments or concerns
Enter details here...
Signature of Client
Sign here
Date of Submission
03/15/1985
Submit
Use this template

Sign up and start customizing in minutes.

Start with the Massage Therapy Intake Form template and tailor it to your practice. It includes 17 editable fields across 1 page. Included questions: Full Name, Date of Birth, Contact Information (Phone or Email), Emergency Contact (Name and Phone Number). The full field list below shows what you will get when you add this template to your account.

Choose this template to open an editable form. Review the questions, keep only the information your practice needs, and add your branding. Preview the patient experience before sharing a link or embedding the form. Responses can be reviewed in Formisoft and exported as a PDF.

What's included

  • Full Name
  • Date of Birth
  • Contact Information (Phone or Email)
  • Emergency Contact (Name and Phone Number)
  • Have you had a professional massage before?
  • What is the primary reason for today's massage? (e.g., relaxation, pain relief, injury recovery)
  • Are there any specific areas of the body you'd like us to focus on?
  • Please indicate any areas of the body you would like us to avoid
  • Do you have any of the following health conditions? (Check all that apply)
  • If you selected 'Other', please specify
  • Are you currently taking any medications?
  • If yes, please list your medications
  • Do you have any allergies (e.g., lotions, oils, essential oils)?
  • Preferred pressure level for the massage
  • Additional comments or concerns
  • Signature of Client
  • Date of Submission

Who uses this template

  • Licensed massage therapy and bodywork practices
  • Spa and wellness center massage services
  • Sports massage and athletic recovery programs
  • Prenatal and postnatal massage clinics

All form fields

17 fields across 1 page. Customize any field after signing up.

Full NameText
Date of BirthDate
Contact Information (Phone or Email)Text
Emergency Contact (Name and Phone Number)Text
Have you had a professional massage before?Dropdown
What is the primary reason for today's massage? (e.g., relaxation, pain relief, injury recovery)Long Text
Are there any specific areas of the body you'd like us to focus on?Long Text
Please indicate any areas of the body you would like us to avoidLong Text
Do you have any of the following health conditions? (Check all that apply)Checkbox
If you selected 'Other', please specifyLong Text
Are you currently taking any medications?Dropdown
If yes, please list your medicationsLong Text
Do you have any allergies (e.g., lotions, oils, essential oils)?Long Text
Preferred pressure level for the massageDropdown
Additional comments or concernsLong Text
Signature of ClientE-Signature
Date of SubmissionDate

How to use the Massage Therapy Intake Form

Getting started with this template takes just a few minutes. Sign up for a Formisoft trial, then select the Massage Therapy Intake Form from the template library. Review the included questions, customize your fields, and preview the form before sharing it.

Setup steps

  1. 1Choose the template. Find the Massage Therapy Intake Form in the template library and click “Use this template” to add it to your account.
  2. 2Customize fields. Add, remove, or reorder any of the 17 fields. Set fields as required or optional based on your practice needs.
  3. 3Brand it. Upload your logo, pick your colors, and add a custom welcome message so patients see your practice identity.
  4. 4Share with patients. Send the form via SMS, email, or embed it on your website. Patients complete it on any device before their visit.
  5. 5Review submissions. Responses appear in your dashboard in real time. Patient records are created automatically from the data collected.

Frequently asked questions

How does Formisoft protect responses?

Formisoft provides secure form collection and a Business Associate Agreement (BAA). Your practice must review the form content, access permissions, and sharing workflow for its requirements.

Can I customize the fields in this template?

Absolutely. You can add, remove, reorder, or modify any of the 17 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

How do patients fill out this form?

Patients receive a link via SMS, email, or QR code. They complete the form on their phone, tablet, or computer before their appointment. No app download required.

Can I send this form automatically before appointments?

With a plan that includes automation, you can configure workflows to send forms and reminders. Appointment-based sending requires the booking event to reach Formisoft.

Does this template work on mobile devices?

Yes. The Massage Therapy Intake Form is fully responsive and works on any device. Most patients complete intake forms on their phone, so every template is optimized for mobile-first use.

Start with this template

Sign up and start customizing the Massage Therapy Intake Form for your practice. Set up in minutes.

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