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Healthcare & Wellness
Massage Therapy Intake
Modality-specific intake for massage clients — mark tension areas on a body sketch, set pressure preferences, and flag anything the therapist should avoid before the session.
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Preview · not interactiveMassage Therapy Intake
Modality-specific intake for massage clients — mark tension areas on a body sketch, set pressure preferences, and flag anything the therapist should avoid before the session.
Your details
Your name*
Email address*
Appointment reminders and aftercare tips go here.
Phone number*
Include your country code
Date of birth
Pick a date📅
Emergency contact name*
Emergency contact phone*
Include the country code
Where should we focus?
Sketch your tension or pain areas*
⬆ Drop a file or click to upload
Preferred pressure*
Any areas we should avoid?
e.g. lower back, left shoulder, feet
Do any of these apply to you?*
Select…▾
Are you currently pregnant?*
Yes
No
Prefer not to say
Prenatal massage uses adapted positioning and techniques.
Goals & consent
What is your main goal for this session?*
Select…▾
Consent to treatment*
Consent to treatment
Signature*
Sign here
Sign with your finger or mouse to confirm the details above.
Submit