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Massage Therapy Client Questionnaire Mobile App

The Massage Therapy Client Questionnaire mobile app makes it easy for patients to complete a health questionnaire when they see new massage therapist. The massage session intake form helps ensure that massage therapists have all the information they need to treat a patient. The Massage Therapy client template also makes it easy to get client consent for your services before the professional massage therapy service begins.

With the electronic client intake form, any massage therapist can easily gather client feedback about previous professional massage treatments, health history and medical conditions, areas of muscular tension, use of pain medication, and current range of motions for specific joints and muscles. Each massage therapy client form is saved in your canvas Cloud account and can be shared as a PDF.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Massage Therapy Client Questionnaire Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Date:

  • Ico textbox

    Name:

  • Ico date

    D.

  • Ico textbox

    Gender:

  • Ico textbox

    S.

  • Ico textbox

    M.

  • Ico multiline

    Address:

  • Ico textbox

    Home Phone:

  • Ico textbox

    Work Phone:

  • Ico textbox

    Occupation:

  • Ico textbox

    Referred by:

  • Ico dropdown

    Have you had a professional massage prior to this visit?

  • Ico multiline

    Reason for therapeutic massage (major complaint):

  • Ico multiline

    What, if any, treatment have you had for this condition?

  • Ico multiline

    Is there anything that makes your condition worse?

  • Ico statictext

    Please note if you are currently being treated by any of the following practitioners:

  • Ico textbox

    Medical Doctor (MD) or Nurse Practitioner (NP)

  • Ico dropdown

    Release:

  • Ico textbox

    Chiropractor

  • Ico dropdown

    Release:

  • Ico textbox

    Psychiatrist

  • Ico dropdown

    Release:

  • Ico dropdown

    Have you had any surgery?

  • Ico multiline

    (If yes, please explain.

  • Ico textbox

    Emergency Contact Name & Relation to You:

  • Ico textbox

    Phone:

  • Ico dropdown

    Desired Massage Pressure:

  • Ico statictext

    Sleeping Position:

  • ...and More!

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