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Massage Patient Health In-Take Form w/ Drawing Mobile App

Save time and complete this Massage Patient Health In-Take Form right on a mobile device or tablet. Perfect for massage therapy practices, the form allows patients at each appointment to enter all details such as medical history, the form of massage they desire, a drawing tool to indicate any problem areas with muscle tension, a checklist for areas you do not want massaged, surgeries, accidents, allergies, medications and more. This type of information is important for all client intake appointments to decide which massage therapy treatment is best.

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

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Take a peek inside the Massage Patient Health In-Take Form w/ Drawing Mobile App

Included Features

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Included Fields

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

  • Ico textbox

    Name

  • Ico textbox

    DOB

  • Ico textbox

    Address

  • Ico dropdown

    State

  • Ico textbox

    Zip

  • Ico textbox

    Phone (Home)

  • Ico textbox

    (Work)

  • Ico textbox

    Emergency Contact

  • Ico textbox

    Phone

  • Ico textbox

    Email Address

  • Ico textbox

    How did you hear about us?

  • Ico drawing

    Please draw a picture of your body and circle any problem areas

  • Ico textbox

    Have you received a professional massage before?

  • Ico statictext

    Are there any areas of your body that you "do not" want massaged?

  • Ico checkbox

    Face

  • Ico checkbox

    Scalp

  • Ico checkbox

    Neck

  • Ico checkbox

    Upper Chest

  • Ico checkbox

    Shoulders

  • Ico checkbox

    Stomach

  • Ico checkbox

    Upper back

  • Ico checkbox

    Mid back

  • Ico checkbox

    Lower back

  • Ico checkbox

    Arms

  • Ico checkbox

    Hands

  • Ico checkbox

    Guteals

  • Ico checkbox

    Legs

  • Ico checkbox

    Feet

  • ...and More!

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