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Massage intake form template

Plan a safe massage before the client is on the table: what they want, where to work, how firm, and the precautions that change it.

19 questions · about 4 min · logic · e-signature · prefill from the link

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Full name (required)

Mobile (required)

Is the person having the massage under 18? (required)

What you get back

Every response lands in your results the moment it is sent. Turn on email notifications and each one arrives like this, and the same answers become a row in your spreadsheet.

From PulseFormCreator

Subject New response to Before your massage

Full name
Nadia Haddad
Mobile
+61423555614
Email
nadia.haddad@example.com
Is the person having the massage under 18?
No
Have you had a professional massage before?
Once or twice
What would you like from this massage?
Ease tension or stiffness

and 11 more answers

A sample email with made-up answers.
submitted_atFull nameMobileEmailIs the person having the massage under 18?Parent or guardian’s name
2026-09-22T09:41:00.000ZNadia Haddad+61423555614nadia.haddad@example.comNo

The first 6 of 59 columns. Export to CSV or Excel, or send each response to Google Sheets, Notion, Airtable, Slack or a webhook as it arrives, all on the free plan. The answers above are made up.

What this form asks, and why

The last column shows how many of the 17 real massage intake forms we read ask the same thing.

Question Why it is there Real forms
Full name Required Matches the form to the booking. 17 of 17 forms
Mobile Required For a running-late text or a changed time. 16 of 17 forms
Email Required Reminders and rebooking. 14 of 17 forms
Is the person having the massage under 18? Required Replaces the date of birth asked on 15 of 17 forms: age only decides who consents. 15 of 17 forms
Parent or guardian’s name Required Only when “Is the person having the massage under 18?” is Yes Shown for under-18s, who need a parent’s consent. 3 of 17 forms
Have you had a professional massage before? A first-timer gets draping and check-ins explained. 11 of 17 forms
What would you like from this massage? Required Relaxation and a stiff neck are different massages. 11 of 17 forms
Where would you like us to focus? A list instead of a body outline, which is hard to mark on a phone. 5 of 17 forms
Anywhere you would rather we did not massage? Feet, face, a scar: said before the session, not during it. 6 of 17 forms
What pressure do you like? Only 6 of 17 forms ask, though it shapes the whole hour. 6 of 17 forms
Do you find it hard to lie on your front, back or side? A yes means side-lying or extra support, set up in advance. 3 of 17 forms
Does any of this apply to you at the moment? Required Conditions that change where, how firmly or whether to massage. Some end on a check-in screen. 15 of 17 forms
Anything else your therapist should know? The only free-text health box: a safety check, not a medical history. 5 of 17 forms
Changes Required So one intake covers later visits. 8 of 17 forms
Not medical treatment Required Therapists do not diagnose or prescribe, and 11 of 17 forms say so. 11 of 17 forms
Draping and conduct Required Draping, stopping at any time and what ends a session, in one tick. 6 of 17 forms
Cancellations Required Your notice period and fee. Link your policy. 5 of 17 forms
Health answers Required Health answers are sensitive, so the client agrees to you keeping them. 3 of 17 forms
Signature Required Confirms the answers are true, like the declaration on 12 of 17 forms. 14 of 17 forms

What we left out

  • A list of medications. Asked on 15 of 17 forms. The precautions list asks about blood thinners, which change how firmly to work; the free-text box takes the rest.
  • GP details and medical history. GP details on 8 of 17 forms; family history and an “AIDS or STD” question on 1 of 17 forms each. None of it changes the massage.
  • Occupation and postal address. Each asked on 12 of 17 forms. Nothing is posted, and work comes up on the table.

What 17 real massage intake forms ask

In September 2026 we read 17 massage intake forms that organisations use today (US 9, UK 7, Canada 1) and recorded every field. This is how often each one appears. It is part of the Form Field Index.

  1. Name 17 of 17 (17 of 17 forms)
  2. Phone number 16 of 17 (16 of 17 forms)
  3. Date of birth 15 of 17 (15 of 17 forms)
  4. Medical conditions 15 of 17 (15 of 17 forms)
  5. Medications 15 of 17 (15 of 17 forms)
  6. Allergies 14 of 17 (14 of 17 forms)
  7. Diabetes 14 of 17 (14 of 17 forms)
  8. Email address 14 of 17 (14 of 17 forms)
  9. Heart condition 14 of 17 (14 of 17 forms)
  10. Pregnant (and how far along) 14 of 17 (14 of 17 forms)
  11. Recent surgery or injury 14 of 17 (14 of 17 forms)
  12. Signature 14 of 17 (14 of 17 forms)
The 17 forms we read
  1. Advanced Holistic Health LLC · massage and holistic therapy practice, US
  2. Mindful Massage & Wellness · massage therapist, US
  3. Indy North Massage · massage clinic, US
  4. All Is Well Holistic Spa & Massage · massage spa, US
  5. Freedom Chiropractic Health Center (massage therapist) · chiropractic clinic, massage service, US
  6. Hanson Chiropractic Center · chiropractic clinic, massage service, US
  7. Massages4u · massage therapist, UK
  8. Steve Holder Sport Massage Therapy · sports massage therapist, UK
  9. NC Teaching Spa · college teaching spa, Canada
  10. Target Therapies · massage therapy practice, UK
  11. The Osteopathic Practice (Jane O'Connor & Associates), Leamington Spa · osteopathic practice, sports massage service, UK
  12. A'INE Complementary Therapies · complementary therapist, UK
  13. Jake's Place Men's Barbering Lounge and Spa · men's barber and spa, US
  14. AL!VE · wellness center, US
  15. Somatic Massage Therapy & Spa · massage and spa, US
  16. NW Sports Massage Therapy · sports massage therapist, UK
  17. Revive Massage · massage therapist, UK

How the form changes as people answer

Most people see a shorter form. These questions and screens only appear when an answer calls for them.

  1. When “Is the person having the massage under 18?” is Yes

    shows “Parent or guardian’s name”

  2. When “Does any of this apply to you at the moment?” is Pregnant, Blood clots or DVT, now or in the past, Surgery, a fracture or an injury in the last three months, A heart condition, or high or low blood pressure or Cancer treatment now or in the last year

    shows the “Thanks, …. Your therapist will check in first.” ending

  3. At the end

    shows one of 2 thank-you screens: “Thanks, …. Your therapist will check in first.”, “Thanks, …. See you soon.”

Make it yours

  1. Send it with the booking

    Add ?name=Nadia Haddad to the link in your confirmation and the form opens with her name filled in.

  2. Match the precautions to your training

    Edit the list to the contraindications your association or insurer teaches. Keep “None of these” last: it clears the other ticks.

  3. Keep it to your clients

    Turn on Password protection under Settings → Access and limits, and give the password with the booking.

Good practice and the law

This is general information, not legal advice. Rules differ by country and state, so check anything important where you operate.

  • US

    PulseFormCreator is not HIPAA compliant. HIPAA covered entities, such as practices billing health insurance electronically, should use a compliant system. CMS, HIPAA covered entities

  • UK

    Health answers are special category data under UK GDPR and need a condition such as explicit consent. ICO, special category data

  • Australia

    Health details are sensitive information under the Privacy Act, and complementary therapists are covered whatever their turnover. OAIC, small business

Questions about this template

Why does it ask about blood clots and pregnancy?

Both change the massage: a clot is a reason not to work the area, and pregnancy changes how the client lies.

Does a tick in the precautions list mean no massage?

No. Some end on a check-in screen: the therapist may adjust the massage or ask for a doctor’s go-ahead.

How often should clients fill it in?

Once. The health-changes tick covers later visits; send it again after an injury or a year.

Can I use it for sports or remedial massage?

Pick “Sports or remedial” above the preview: sport, level, event date, and how long and how much it hurts.

Which form do you need?

The massage intake form is one of the intake forms. If it is not quite the job, one of these may be.

Start with the massage intake form template

Open it in the editor and match the precautions to your training.

Use this template

Updated 22 September 2026. Evidence read September 2026 from 17 real forms.