Templates · Free template · Massage therapy
Massage Therapy Intake Form Template
A printable intake form for RMTs and massage clinics covering health history, reason for visit, pain and body areas, medications, and pressure preferences, followed by consent to treat.
Screen first, then treat
The form's main job is to tell you when not to massage, or to modify the treatment: recent surgery, blood clots, infection, fever, and some medications all matter. Ask clearly and follow up on any yes.
It also sets up the treatment: the reason for visit, the areas of concern, pain levels, and pressure preference. Keep the answers with the client's record so the initial assessment starts from them.
Massage Therapy Intake Form
Client
Reason for visit
Health history
Consent to treatment
Signatures
Template from zdrovia.ca/templates/massage-therapy-intake-form/ · Review with your medical director, regulatory college guidance, and insurer before use.
Send this form before the appointment instead of printing it
Zdrovia's form builder turns this template into a digital form your clients sign on their own phone. The signed copy files into their chart with the exact version they saw, and photo consent stays separate from treatment consent. It's free for solo practitioners, with data stored in Canada.
See how Zdrovia is set up for massage therapists.
Frequently asked questions
How often should the form be updated?
Ask returning clients to confirm health changes at each visit, and to complete a fresh form once a year.
Should intake include a body diagram?
A diagram helps clients show where symptoms are. Add one if your workflow uses it.
Related
This template is a starting point for discussion with your team and advisors, not legal or medical advice. Requirements vary by province and profession. Have your medical director, your regulatory college's guidance, and your malpractice insurer confirm the wording before you use it with patients.