Massage Therapy Intake Form
Asks about contact information (Phone or email), emergency contact (Name and phone number), and have you had a professional massage before. Built for licensed massage therapy and bodywork practices.
- Questions
- 17
- Page
- 1
- Time
- about 4 min
Includes
- E-signature
Your practice
Live preview. Tap through it like a patient.
Who it is for
- Licensed massage therapy and bodywork practices
- Spa and wellness center massage services
- Sports massage and athletic recovery programs
- Prenatal and postnatal massage clinics
What's inside
- Full NameText · Required
- Date of BirthDate · Required
- Contact Information (Phone or Email)Text · Required
- Emergency Contact (Name and Phone Number)Text
- Have you had a professional massage before?Dropdown · 2 choices · Required
- What is the primary reason for today's massage? (e.g., relaxation, pain relief, injury recovery)Long Text · Required
- 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 · 10 choices
- If you selected 'Other', please specifyLong Text
From form to a ready patient

01
Make it yours
Reword, reorder, or add to the Massage Therapy Intake Form, and add your logo.

02
Patients finish it at home
A secure link by text or email, filled out on their phone before the visit. No app.

03
Your team sees who is ready
Each visit shows as ready once its forms are in. Answers land on the patient record.
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Questions
Send it before the visit, so patients arrive ready.
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