provides access to forms to help manage your wellness and relaxation goals:
Click on the title of each of the forms to open the document. Save the document to your desktop.
Fill out the document online, if applicable, and save the document. If you are not able to fill
out the document online, print it out, complete it, and then scan the completed form.
Please complete all necessary forms prior to your session.
Email the completed form(s) to firstname.lastname@example.org.
Intake and Health Information Form
This form is required for new clients prior to the first therapy session. Information requested includes client contact information, basic health information, goals for massage therapy treatment, and consent to treatment.
This form is required for new clients prior to the first therapy session. Information includes the COVID-19 massage therapy and treatment procedures, assesses exposure risks to COVID-19 for treatment considerations, and obtains client consent for massage amid the Covid-19 pandemic.
COVID-19 Addendum Update
This form is required for all clients prior to all subsequent therapy sessions after the initial intake. Questions assess exposure risks to COVID-19 for treatment considerations since the last therapy session.
Health Status Update Form
This form is required whenever there is a change in the client’s health.
Client Feedback Form
This form may be used by a client to provide helpful feedback to the therapist on the completed massage therapy session.
This form is an aid for therapy sessions. It contains an anterior and posterior view of the body and a listing of many of the common muscles treated during massage therapy sessions. Clients may use this tool to pinpoint areas of discomfort or sources of pain for the therapist. It also gives the therapist a way to document treatment for referrals to other practitioners.
Physician Permission Form
This form will be provided to a client by the therapist when permission is needed from the client’s physician to provide massage therapy to the client or to treat a particular area of the client’s body. The form asks a physician to indicate that there are no contraindications to massage for the client.
Physician Referral Form
Th is form may be used by a client to receive a referral to the massage therapist. The form includes information from the physician about the type of treatment and benefits being sought for the client.