Massage therapy intake form
An intake form captures what a client is asking for before you meet them, so the first appointment is treatment, not interview. Areas of tension and pain level are structured fields a therapist can read before the client is in the room, which saves appointment time and lets you prep focused work instead of hunting.
The form beside this text is live. Fill it in and submit it — it validates exactly as it would for a real respondent, and saves nothing.
Pain level as a slider, not free text
A 0-10 slider field gives the therapist a structured number — 7 or 3 — that is comparable across clients. "Some pain in the lower back" is a description that takes longer to read and does not sort or average.
Checkbox group for multiple areas of focus
A client often has tension in several places, so a checkbox group lets them name all of them at once. A single-choice radio would hide the second or third area from the therapist until the appointment.
No card required.
Massage Therapy Intake Form
Live previewHow to build this form
5 steps in the editor. Nothing here needs a paid plan.
- Add short text, email and phone fields for the client's name and contact details.
- Add a checkbox group for areas of tension or focus: neck, shoulders, lower back, legs. Clients may select multiple.
- Add a slider field for pain level, set to 0-10 in the settings, so the therapist sees a number instead of reading descriptions.
- Add a long text field for health conditions to be aware of — injuries, surgeries, medications — and leave it optional.
- Add a radio group asking about prior massage experience: first time, some experience, regular client. That shapes how the therapist opens the session.
Fields in this form
7 fields, using 7 of the 19 field types available.
| Question | Field type | Required |
|---|---|---|
| Full name | Short text | Yes |
| Yes | ||
| Phone | Phone | Yes |
| Areas of tension or focus | Checkboxes | Yes |
| Current pain level (0 = none, 10 = severe) | Slider | Yes |
| Health conditions or injuries to be aware of | Long text | Optional |
| Prior massage experience | Radio buttons | Yes |
What goes wrong with this form
Specific to a massage therapy intake form, not general advice about forms.
Pain level as free text
Avoid a text field asking "how does it hurt". Use a slider field set to 0-10 instead, so the therapist sees a number: 6, 8, 3. Numbers are comparable across clients and faster to read than parsing sentences.
Single-choice areas of focus
Many clients have tension in multiple places — neck and shoulders both, or lower back and legs. A checkbox group lets them name all the areas; a radio forces them to pick one and hides the rest.
Skipping health conditions because it's optional
Leave the health conditions field optional because not every client has anything relevant to share, but prompt for it. A therapist working blind on a client with a recent shoulder surgery is a safety issue that a short optional text field catches.
Questions about this form
What should a massage intake form ask?
Client name and contact info, areas of tension or focus, a pain level on 0-10, any health conditions to know about, and whether they've had massage before. That covers what the therapist needs to know before you meet to plan a focused session.
Is a massage intake form a medical record?
No. This is a general wellness intake, not a clinical or medical document. The therapist will still ask follow-up questions and make professional judgments based on what they see and hear during the appointment. Health conditions you list here do not replace a conversation with the therapist or a doctor.
Why ask about prior massage experience?
It shapes how the therapist opens the session and explains what to expect. A first-time client needs more explanation and reassurance; a regular client knows what pressure to expect and how communication works. Knowing this up front makes the first appointment smoother.
Other templates
- Patient intake formInsurance provider and ID as their own fields, so registering doesn't start with a phone call.
- Appointment Request FormCollect a preferred date, time and reason for visit for clinics, salons and studios.
- Medical HistoryCollect a new patient's medical background before the first appointment.