Medium

Available on

Apple Android Windows

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

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Massage Patient Health In-Take Form w/ Drawing 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.'}}

  • {{data.title}}

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!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Flotation Therapy Consent Form

The Flotation Therapy Consent Form digital app is used by those who operate flotation tanks or float pods for the purpose ...

App Name

Massage Therapy Informed Consent Form

Massage Therapy Informed Consent Form mobile app allows professionals in the massage therapy world to easily distribute an...

App Name

Skin Care History Questionnaire and W...

Complete this Skin Care History Questionnaire so your Skin Care Specialist will have a better understanding of your genera...

App Name

Development of Sanitation Program: Be...

Most bacteria are not a concern for the beverage industry. This is because raw materials, processing techniques and the fi...

App Name

Family History

The Family History mobile app allows caregivers and family members to maintain an electronic family health history using a...

App Name

Bacterial or Viral Culture or Parasit...

Request tests quickly with this Bacterial or Viral Culture or Parasite Identification Request - Department of Health (New ...

App Name

Managing Chronic Non-Terminal Pain: F...

The Managing Chronic Non-Terminal Pain: Established Patients on Long-term Controlled Substances mobile app provides proced...

App Name

Pain Questionnaire: Carpal Tunnel

The purpose of the Pain Questionnaire: Carpal Tunnel mobile app is to help identify difficulties that an individual may be...

More Information