Massage Therapy Client Intake Form

Client Intake Form

For massage preferences or modalities
What type of massage are you interested in?

SwedishDeepTissuePrenatalMyo ZenNeural resetReflexologyNeuromuscularTrigger pointManual lymphatic drainageFunctional anatomyReflexologyAdvance Chair MassageShiatsuGeriatric massagePediatric massage
What is your preferred pressure level?

LightMediumFirmDeep
Are there any areas of your body you'd like the therapist to focus on or avoid?
Do you have any specific goals or expectations for this massage session?
Would you like any additional on services?

AromatherapyHot StonesCold StonesCryotherapyHydrotherapyHot Towel TreatmentScalp MassagePercussion MassageInfrared light TherapyRed light TherapySugar Scrub
SENSORY STIMULATION (click all that apply)
What are the color lightings do you like?

OrangeGreenBluePurplePinkWhite
What kind of music would you like?

JazzGospel SoundscapePopClassicalRhythm and bluesCountry musicR&B
What are the refreshments do you like?

coffeeteawaterjerkychips
What are the table warmers do you like?

fanspillowsbolsterblanket
What are the oils you would like to use?

LavenderEucalyptus thievesfrankincense pain -away
What do you want to wear?

SocksSandalsFlip\-flopsRobesHair bunniesHair bonnetsHair clips
Would you like us to talk during massage session?
Is there anything else you'd like us to know before your massage session?
Consent and Agreement:

I have read and understood the information provided above. I consent to the massage treatment and understand that it is not a substitute for medical care. I understand that the massage therapist will need to adjust the pressure and techniques based on my feedback and comfort levels during the session.

Client Signature: ________________________ Date: ____________
Should be Empty: