Massage Client Intake Form

Name

Have you had professional massage previously? If so, how often do you receive massage?

Do you have any allergies to lotions or essential oils?

What is your occupation?

Are you pregnant? If so, how many weeks?

Do you perform any repetitive motions in your work, hobby or home life? Do you sit or stand a lot?

Any previous surgeries?

Do you take any medications?

Do you have difficulty lying on your back, stomach or side?

Are there particular areas of your body where you are experiencing pain, tension or limited range of motion? Please be specific.

Do you have any specific goals for your massage session?

Additional comments