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Massage Therapy Patient Intake Information NameDateAddressCity & StateZipPhone (Cell)(Other)Mandate of BirthOccupationDate of Injury/Onset to an auto accident? (yes/no) If yes: Insurance Company Name Proclaim

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How to fill out massage intake form

01

Begin by providing your personal information such as name, address, contact number, and email.

02

Specify any medical conditions or injuries you may have.

03

Indicate any areas of the body that require special attention or that you would like the therapist to focus on.

04

Mention any preferences or concerns you may have regarding the massage session.

05

Sign and date the form to acknowledge that all information provided is accurate and complete.

Who needs massage intake form?

01

Anyone seeking a massage therapy session should fill out a massage intake form.

02

Massage therapists use this form to gather important information about the client's health history and massage preferences.

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What is massage intake form?

A massage intake form is a questionnaire completed by clients before receiving massage therapy. It collects important information about the client's health history, preferences, and specific conditions to help the therapist provide safe and effective treatment.

Who is required to file massage intake form?

Clients seeking massage therapy services are required to complete and file a massage intake form before their first session.

How to fill out massage intake form?

To fill out a massage intake form, clients should provide accurate information regarding their contact details, medical history, injuries, allergies, and any current medications. It is important to answer all questions honestly and thoroughly.

What is the purpose of massage intake form?

The purpose of a massage intake form is to assess the client's health status, identify any contraindications to massage therapy, and tailor the treatment to meet the individual needs of the client.

What information must be reported on massage intake form?

Information typically reported on a massage intake form includes the client's personal details, medical history, allergies, current health conditions, medications being taken, and any specific areas of concern or preference for massage.

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