Get the free Massage Intake Form - Tree of Life Chiropractic

Patient Name Date Massage Intake Form How do you feel today? No Pain 0 1 2 3 4 5 6 7 8 9 10 Unbearable Pain Using the diagram, please mark the following information: Any areas to be avoided Circle

How to fill out massage intake form

How to fill out a massage intake form:

1. Start by providing your personal information, including your name, address, phone number, and email address. This information helps the massage therapist keep track of their clients and contact them if needed.
2. Next, indicate your date of birth and gender. This information helps the massage therapist understand any specific considerations or restrictions that may apply to your treatment.
3. Specify any medical conditions or allergies you may have. It is crucial to disclose this information to ensure the massage therapist can tailor the treatment to your needs and avoid any potential complications.
4. Mention any medications or supplements you are currently taking. Certain medications may interact with massage therapy, so it's essential for the therapist to be aware of them.
5. Indicate if you have had any recent surgeries, injuries, or accidents. This information helps the massage therapist assess your current health status and adjust the treatment plan accordingly.
6. Fill in the section regarding your current physical and mental health. This includes providing information about any areas of pain or discomfort, stress levels, and any emotional or psychological issues that may affect your well-being.
7. Specify if you are pregnant or if there is a possibility of pregnancy. Pregnancy often requires special considerations and modifications during a massage session, so it's crucial for the therapist to be aware of this.
8. Lastly, sign and date the form, acknowledging that the information provided is accurate and complete. This assures the massage therapist that you have provided them with the necessary details for a safe and effective treatment.

Who needs a massage intake form:

1. Individuals seeking professional massage therapy services.
2. Clients who are new to a particular massage therapist or establishment.
3. People with specific health concerns or conditions that may require special attention during a massage session.
4. Individuals who want to ensure a safe and effective massage experience by providing the therapist with relevant information about their health and well-being.

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What is massage intake form?

The massage intake form is a document used by massage therapists to collect important information about a client's health history, preferences, and any specific concerns they may have.

Who is required to file massage intake form?

Any massage therapist or spa that offers massage services is required to have clients fill out a massage intake form before their first session.

How to fill out massage intake form?

Clients can fill out a massage intake form by providing accurate and detailed information about their health history, any current medical conditions, and their massage preferences.

What is the purpose of massage intake form?

The purpose of a massage intake form is to ensure that the massage therapist has all necessary information to provide safe and effective treatment tailored to the client's individual needs.

What information must be reported on massage intake form?

Information that must be reported on a massage intake form typically includes contact information, medical history, current medical conditions, allergies, and areas of concern for the massage.