Massage intake and consent form template
A massage intake form tells the therapist what they need to know before touching a new client: conditions that change the treatment, medications like blood thinners, a pregnancy, the areas to avoid. The consent part sets the professional boundaries in writing. Read this one below, then open it in SignMaster and let clients complete it on their phone before their first session.
Updated November 5, 2026 · 3 min read
The contract
Gray blanks are yours to fill in before you send. Each signer fills in the blanks in their color.
- You, before sending
- Client
- Massage therapist
Massage Intake and Consent Form
This intake and consent form is completed by Client name (the "Client") for massage at Practice name (the "Practice") with Therapist and license. It is dated Form date and applies to every session until the Client updates it.
1. About you
- Date of birth: Date of birth
- Emergency contact and phone: Emergency contact
- Doctor or other provider treating you now, if any: Current provider
- What brings you in today: Reason for visit
2. Health history
Some conditions change how massage should be done, or mean it should wait. Please answer each line, writing "none" where it doesn't apply.
- Medical conditions, such as high or low blood pressure, heart disease, diabetes, blood clots, varicose veins, cancer, epilepsy, osteoporosis or arthritis: Medical conditions
- Medications and supplements, including blood thinners and any pain relievers taken today: Medications
- Injuries, surgeries or pain in the last two years: Injuries and surgeries
- Skin conditions, rashes, bruises or open cuts: Skin conditions
- Allergies to oils, lotions, nuts, scents or latex: Allergies
- I am pregnant. Weeks: Weeks pregnant
3. Your preferences
Areas to focus on: Areas to focus on. Areas to avoid: Areas to avoid. Preferred pressure (light, medium or firm): Preferred pressure.
4. What massage is and isn't
Massage is offered for relaxation, relief of muscle tension and general well-being. The therapist does not diagnose illness, prescribe medicine or adjust the spine, and massage is not a substitute for medical care. The Client will see a doctor about any condition that needs one.
5. Consent and communication
The Client consents to massage of the areas discussed before the session. The Client will speak up if the pressure, position, temperature or anything else is uncomfortable, and may ask the therapist to change or stop at any time. The therapist may also adjust or stop a session, or ask for a doctor's clearance first, if a health condition makes massage unwise.
6. Draping and boundaries
The Client undresses in private, only to their level of comfort, and stays covered by a sheet or towel except for the area being worked on. The genital area and breast tissue are never uncovered or massaged. Massage here is strictly therapeutic: a sexual remark, request or touch by the Client ends the session at once, and the full fee is still due.
7. Possible effects
After massage, some people feel sore for a day or two, notice light bruising after deep work, feel lightheaded when getting up, or react to an oil or lotion. The Client understands these effects and will mention any concern at the next visit or sooner. This does not excuse the Practice from responsibility for its own negligence.
8. Keeping this form current
The Client will tell the therapist before any later session about new conditions, injuries, medications or a pregnancy, and the Practice may ask the Client to complete a fresh form every Months between updates months.
9. Appointments
Appointments canceled with less than Cancellation notice in hours hours' notice, or missed, are charged Late cancellation fee. A late arrival shortens the session so the next client starts on time, and the full session fee applies.
10. Privacy and minors
The Practice keeps this form and any session notes confidential and shares them only with the Client's written permission or where the law requires. A Client under 18 needs a parent or guardian's written consent, and the parent or guardian stays on the premises during the session.
Contact details
Client phone: Client phone Email: Client email
The health information I have given is complete and accurate to the best of my knowledge, and I consent to massage on the terms of this form.
Client
Massage therapist
Opens it in SignMaster as a template you can edit and send.
A starting point, not legal advice. Have a lawyer review it for your state and situation. If your practice bills health insurance or works under a doctor's referral, add any forms your state board or payer requires.
On this page
Why the intake form matters
The intake is a safety check first. Deep pressure over a recent blood clot, a calf massage during pregnancy, or firm work on a client taking blood thinners can do harm, and a quick health history is how you catch it. The signed form also shows you asked, which is what your liability insurer will want to see if a client later says nobody did.
The consent half protects the relationship. It says what massage is and isn't, how draping works, that the client can stop at any time, and that sexual conduct ends the session. Saying it on paper, calmly, before anyone is on the table, makes it far easier to enforce.
What the template covers
- About the client: date of birth, emergency contact, any current provider and the reason for the visit.
- Health history: conditions, medications, recent injuries, skin issues, allergies to oils or latex, and pregnancy with weeks.
- Preferences: areas to focus on, areas to avoid and preferred pressure.
- Scope: massage isn't diagnosis or medical treatment.
- Consent and communication: the client can change or stop the session; you can stop or ask for a doctor's clearance.
- Draping and boundaries: covered at all times except the area being worked, and a firm line on sexual conduct.
- Possible effects: soreness, bruising, lightheadedness and product reactions.
- Updates, cancellations, privacy and clients under 18.
Mistakes to avoid
- Letting regulars skip updates for years. Health changes; ask returning clients to confirm or refresh the form, and set how often in section 8.
- Yes/no boxes with no room to explain. "Heart condition: yes" tells you little. Free-text answers give you something to act on.
- Collecting the form after the session starts. Read it before the client undresses, so you can adjust the plan or ask for clearance.
- Leaving the boundary rule unwritten. If you'd end a session for inappropriate behavior, say so here and say the fee is still due.
Health information and privacy
SignMaster doesn't claim HIPAA compliance. Massage practices that don't bill health insurance electronically usually aren't HIPAA covered entities, but if yours is, or you work inside a medical practice, check with your compliance adviser before collecting health history through any online tool.
How to send it with SignMaster
- 1
Open the template
Choose Use this template. The client signs first and the therapist second.
- 2
Fill in the practice blanks
Add your practice name, therapist name and license number, cancellation window and fee, and how often clients refresh the form. These gray blanks stay the same for every client.
- 3
Share one link with every new client
Create a public signing link and put it in your booking confirmation. The client fills in the blue blanks, their health history and preferences, and signs before arriving. You're assigned as the therapist, so the form comes to you to countersign.
- 4
Walk-ins sign on your tablet
For someone who arrives without it, open the envelope and use in-person signing at the front desk while they wait.
- 5
Read it before the session
Open the completed form, check the health answers and countersign. Both of you get the signed PDF with a certificate of completion.
A front-desk QR code
A public link can also be a QR code. Print it on a card at reception, and a client can scan it with their phone camera, fill in the form in the waiting area, and sign. The signing page also comes in 6 languages, so a client who reads Spanish more comfortably can switch with one tap.
Questions? Answers.
Do massage therapists need an intake form?
It's standard practice. A health history is how you spot reasons to change or postpone a treatment, and liability insurers and many state boards expect you to keep client records. Check your own board's record-keeping rules.
How often should clients update it?
Ask before every session whether anything has changed, and have regulars complete a fresh form at set intervals. Many practices choose once a year; the template has a blank for your interval.
Can clients fill it in before they arrive?
Yes. Send a public signing link with the booking. They complete it on their phone, and the form reaches you before the appointment.
Is an e-signed consent form valid?
Generally, yes. Federal and state e-signature laws treat electronic signatures like handwritten ones for most records. See can you e-sign a medical consent form for the details.