Massage Therapy Client Intake Form | PDF | RTF | Word
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A massage therapy client intake form can never substitute for your professional massage education, or for the experience that you’ve gained in practice. But it can help to gather all the information in one place, and make it easier for you to provide the type and intensity of massage best suited for your client’s needs and wants.
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How to Fill-in
The first block of information on a Massage Intake Form is the client’s personal information, such as name and address, birth date, phone number and email address. It’s also important to take down the client’s physician’s contact number, just in case. And while it may not be a factor in how you’ll proceed with the massage, for marketing purposes, you’ll certainly want to know how the client heard about your service in the first place.
The next area on your Massage Intake Form should contain information on your client’s current state of health. Included here should be the reason why the client feels that a massage might be necessary or desirable at this time. If there is a specific anatomical area that needs attention, the client should mention it here.
Although you, the massage therapist, are not a medical provider per se, you certainly need to know about the client’s medical profile. The next section of a good Massage Intake Form should gather that information. Questions that must be asked include inquiring if the client is currently under a physician’s care, and, if so, why? The client must list all medications currently prescribed, and the conditions for which they needed. And, of course, you need to learn what sort of work the client does, and the type of sports activities he or she engages in now and in the past.
As a massage therapist, you must certainly be very concerned with learning about any surgeries that the client has undergone, and if there have been any major accidents. The Massage Intake Form must certainly ask these questions, and the Medical Profile Section must provide adequate space to list, describe and date each occurrence. And finally, the client needs to list any sort of communicable disease that he or she is currently dealing with.
The last part of the Massage Intake Form is about consent and risk. What needs to be included here, besides the client’s dated signature, will depend on what state you practice in. Consult your state’s Massage Therapist’s Association to find out what’s needed in your jurisdiction.
Download (PDF, 81KB)
Sources
http://brightnesswithin.com/wp-content/uploads/2012/05/Client-Intake-Form.doc
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