Massage intake form: free printable template (PDF)

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This template is general information, not medical or legal advice. Adapt it to your treatments, your insurer's requirements and any license conditions in your area. When a client reports a condition you are unsure about, ask them to check with their doctor before the treatment.

The form

Client intake form

Please complete before your first treatment. Your answers help your therapist treat you safely. All information is kept confidential.

1. Your details

Full name

Date of birth

Phone and email

Emergency contact (name and phone)

Physician (optional)

2. Health: do any of these apply to you now or recently?

Fever, infection or feeling unwell today
Recent surgery (last 6 months)
Blood clots / DVT, or on blood thinners
High or low blood pressure
Heart condition or pacemaker
Pregnancy (and how many weeks)
Skin conditions, rashes, cuts or bruises
Recent injury, sprain or fracture
Varicose veins
Cancer, or current cancer treatment
Diabetes
Epilepsy
Osteoporosis
Joint replacement or metal implants
Allergies (oils, nuts, latex, fragrance)
Back or neck problems
Headaches or migraines
Other condition or medication

If you ticked anything, please give details

Medication you take regularly

3. Your treatment

What would you like from the treatment (relaxation, tension, a specific area, sport or injury)?

Preferred pressure: light / medium / firm. Areas to avoid:

4. Consent

I confirm the information above is correct and I will tell my therapist if anything changes.
I consent to the studio keeping the health information on this form to provide safe treatment. I understand I can withdraw this consent and ask for the information to be deleted at any time.
(Optional) I would like to receive offers and news from the studio by email or text. I can unsubscribe at any time.

Client signature and date

5. Therapist notes (salon use)

Treatment given, oils used, observations, advice given

Therapist name, signature and date

[Studio name, address, phone]. Your information is kept confidential and used only to provide safe treatment. We keep this form for [period] after your last visit.

How to use the form well

Before the first visit. Send the questions with the booking confirmation or have the client fill them in at the front desk ten minutes early.
Read it with the client. A two-minute conversation catches what a tick box does not, such as how many weeks pregnant or which shoulder.
Separate the consents. Consent to keep health data is one tick box; marketing is a different, optional one. Never make treatment depend on marketing consent.
Store it securely. Lockable storage for paper, access only for therapists; on a digital system, staff accounts with roles.
Update it. Ask "anything changed since last time?" at every visit and note the answer.

Keep intake notes on the client card instead of paper

In Rytuo the client's health notes and preferences sit on the client card next to their visit history, packages and gift certificates, and the therapist sees the note with the booking in her app, for example "sensitive lower back" before a 19:00 couples massage. Staff accounts have roles (owner, manager, reception, therapist), and every change is recorded with who made it and when. See massage therapist software or online booking.

Frequently asked questions

What is a massage intake form?

A short questionnaire a client fills in before the first massage (and updates when something changes). It records contact details, health conditions that may mean a treatment should be adapted or postponed, medication, allergies, the client's goals and pressure preferences, and the client's consent to the treatment and to the studio keeping this information.

Is a massage intake form required by law?

Requirements depend on your state, your license and your insurer. Many state massage boards and liability insurers expect therapists to take and keep a health history before treating, and it is your best record if something goes wrong. Check your state board's rules. This page is general information, not legal advice.

Does HIPAA apply to my massage intake forms?

It depends on your business. Under the HIPAA rules, "covered entities" are health plans, health care clearinghouses and health care providers who transmit health information electronically in connection with certain standard transactions (such as insurance claims), and the rules also reach their business associates. Many cash-pay massage studios are not covered entities, while practices that bill insurance may be. Ask a professional if you are unsure. Either way, treat intake forms as confidential: store them securely and share them only with the therapists who need them.

How often should a client update the form?

At the first visit, then whenever their health, medication or pregnancy status changes. Many studios ask a quick "anything changed since last time?" at every visit and a full update once a year.

Can I keep intake notes digitally?

Yes, and it is usually safer than paper in a folder at the front desk. In Rytuo, health notes live on the client card, visible to staff who need them, and therapists see the relevant note with the appointment in their app.

Is this form suitable for sports massage or SOAP notes?

It covers the standard health questions. For sports massage add the client's sport, training load and the injury or area to focus on; the therapist notes section can be used for short SOAP-style notes (subjective, objective, assessment, plan).

Sources

45 CFR 160.103 HIPAA definitions, including "covered entity" (eCFR), checked November 9, 2026

Information checked on November 9, 2026. Rules and figures change; if something here is out of date, email [email protected] and we will correct it within 7 days.

Massage intake form: free printable template.