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Massage Therapy Client Health Intake Form Patient Information Name Address City State Zip Home Phone Work/Cell Phone E-mail Occupation Date of Birth Emergency Contact Person Phone Are you currently under a physicians care for an acute or chronic illness Y N If yes please explain If yes who is your health care provider Have you received a massage before Y N If yes when How did you hear about me What are your goals for this session Please list areas of tension stress and/or pain you wish to be...
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How to fill out intake editable form
How to fill out massage intake form:
01
Start by providing basic personal information such as your name, contact details, and date of birth.
02
Next, indicate any medical conditions, allergies, or specific concerns you may have so that the massage therapist can tailor the session accordingly.
03
Specify your massage preferences, including the type of massage, pressure preference, and any areas of the body you would like the therapist to focus on or avoid.
04
Communicate any past injuries or surgeries that may affect the massage session.
05
If you are pregnant, mention your gestational age and any specific prenatal considerations.
06
Indicate any medications you are currently taking, as some medications may interact with certain massage techniques.
07
Finally, read through the form to ensure all information is accurate and complete before signing and submitting it to the massage therapist.
Who needs a massage intake form:
01
Individuals seeking professional massage therapy services.
02
People with specific health conditions or concerns that may impact their massage session.
03
Anyone who wants to ensure a personalized and safe massage experience.
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What is massage intake forms?
Massage intake forms are documents that massage therapists use to collect information from their clients prior to providing massage services. This form typically includes questions about the client's medical history, current health status, and massage preferences. These forms are used to ensure that the massage therapist is aware of any medical conditions or other issues that could affect the massage treatment.
How to fill out massage intake forms?
1. Start with the client's personal information: Name, address, phone number, and email address.
2. Ask the client about their medical history: Any past or current medical conditions, allergies, injuries or surgeries relevant to massage therapy, medications, and lifestyle habits.
3. Ask the client what their massage goals are: Are they looking to reduce stress or chronic pain, increase mobility, or just relax?
4. Ask the client about any areas of discomfort: Are there any particular areas that need extra attention or are sore or tight?
5. Ask about the client's pressure preference: Are they comfortable with a deep tissue massage or do they prefer a lighter touch?
6. Ask if the client has any contraindications: Are there any areas they would like to avoid during the massage?
7. Ask if they have any other requests: Are there any particular techniques or aromatherapy oils they would like incorporated into the massage?
8. Ask for their signature: This acknowledges that they have read, understand, and agree to the release of information.
What is the purpose of massage intake forms?
Massage intake forms are used to gather information about a client's health history, current medical conditions, and preferences for massage. This information is used to ensure the massage therapist has a full understanding of the client's needs and can provide the most beneficial and safe massage session.
When is the deadline to file massage intake forms in 2023?
The exact deadline for filing massage intake forms in 2023 will depend on the specific regulations and requirements of the massage therapy business. However, it is generally recommended that these forms are filled out and submitted at least 24 hours before the appointment.
What is the penalty for the late filing of massage intake forms?
The penalty for the late filing of massage intake forms will depend on the laws of the jurisdiction where the massage is being provided. In some jurisdictions, there may be no penalties, while in others, late filing may result in fines or other disciplinary action.
Who is required to file massage intake forms?
Massage therapists are typically required to have clients fill out intake forms before their first session. These forms help gather important information about the client's medical history, current health status, any allergies or past injuries, and any specific goals or concerns they may have for the massage session. Filling out intake forms is essential for both client and therapist to ensure a safe and effective massage experience.
What information must be reported on massage intake forms?
The specific information that must be reported on massage intake forms may vary depending on the requirements of the massage therapist or the particular establishment. However, some common information typically requested on these forms include:
1. Personal information: Name, address, phone number, and email address of the client.
2. Health history: Any medical conditions, injuries, surgeries, or chronic illnesses that might affect the massage treatment.
3. Medications: Details of any medications or supplements currently being taken by the client.
4. Allergies: Any known allergies, including allergies to oils, lotions, or other massage products.
5. Pregnancy information: For female clients, it is essential to know if they are pregnant, as some massage techniques may need to be modified for safety.
6. Pain or discomfort: Any specific areas of pain, discomfort, or tension that the client wants the therapist to focus on.
7. Goals and preferences: The client's preferences regarding pressure, techniques, or specific areas that should be avoided or emphasized during the massage.
8. Informed consent: A section where the client acknowledges that they have been informed about the nature of the massage therapy, its potential benefits, risks, and any concerns they may have.
9. Signature and date: A space for the client to sign and date the intake form, indicating their agreement and understanding.
It is important to note that all information provided on massage intake forms is considered confidential and should be protected accordingly.
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