Template: Medical IntakeMassage Client Intake Form Form TemplateUse This Template Collect necessary health and preference information from clients prior to a massage session.This is a preview of the template. Click here to use it.Full Name *Date of Birth *Contact Information (Phone or Email) *Emergency Contact (Name and Phone Number) Have you had a professional massage before? *YesNoWhat 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) High Blood PressureHeart ConditionsDiabetesArthritisRecent InjuriesChronic PainSkin ConditionsAllergiesPregnancyOther (please specify)If you selected 'Other', please specify Are you currently taking any medications? *YesNoIf yes, please list your medications Do you have any allergies (e.g., lotions, oils, essential oils)? Preferred pressure level for the massage *LightMediumFirmAdditional comments or concerns Signature of Client *Sign HereDate of Submission *Use This Template