Massage Client Intake Form

Massage Client Intake Form

Helping us to guide clients properly. Form Preview
  • Active-Passive Massage Motion, House Call Massage

  • Intake form

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  • ***Draping will be used during the session – only the area being worked on will be uncovered.

    ***Clients under the age of 16 must be accompanied by a parent or legal guardian during the entire session.

    Minor consent must be filled by parent or legal guardian for any client under the age of 16.***


    I, understand that the massage I receive is provided for the basic purpose of relaxation and relief of muscular tension.

    If I experience any pain or discomfort during this session, I will immediately inform the therapist so that the pressure and/or strokes may be adjusted to my level of comfort.

    I further understand that massage should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or other qualified medical specialist for any mental or physical ailment that I am aware of.

    I understand that massage therapists are not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such.

    Because massage should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly.

  • Client Consent Form


    I have informed the massage therapist of all my known physical conditions, medical conditions and medications, and I will keep the massage therapist updated on any changes.

    I understand that there shall be no liability on the practitioner’s part due to my forgetting to relay any pertinent information.

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