← All free templatesClient intake form template

A free client intake form.

A first-visit health questionnaire that covers the essentials safely — contact and GP details, medical history, what brought them in, and clear consent. Print it as a blank form to hand over, or use it as the basis for your own.

New client intake & consent form

Please complete before your first treatment.

Your details

Full name

Date of birth

Address

Postcode

Phone

Occupation

In case of emergency

GP name & practice

GP phone

Emergency contact name

Emergency contact phone

About your health

Please tick anything that applies, then add detail below. This helps me treat you safely — most conditions simply mean I adapt the treatment, and a few mean I’ll ask for your GP’s go-ahead first.

Heart & circulation

Heart condition or heart disease

High or low blood pressure

Thrombosis, phlebitis or poor circulation

Varicose veins

Bleeding disorder or taking blood thinners

Bones, joints & muscles

Arthritis or rheumatism

Osteoporosis

Recent fracture, sprain or injury

Back, neck or slipped-disc problem

Whiplash

Nervous system

Epilepsy

MS, Parkinson’s or other neurological condition

Trapped or inflamed nerve, e.g. sciatica

Migraines or frequent headaches

Skin

Skin condition (eczema, psoriasis, dermatitis)

Cuts, bruises, rashes or recent sunburn

Undiagnosed lumps, swelling or inflammation

General health

Diabetes

Asthma or other respiratory condition

Cancer, now or in the past

Digestive, liver or kidney condition

Fever, cold, flu or infection right now

Stress, anxiety or other mental-health condition

Women’s health

Pregnant or recently given birth

Currently menstruating

Medication, allergies & recent treatment

Taking any prescribed medication

Allergies — including to nuts, oils or lotions

Operation or surgery in the last two years

Currently under a doctor or other therapist

If pregnant, how many weeks?

Allergies (especially oils, lotions or nuts)

Please give details of anything ticked above, including any medication and dates of recent surgery

Your treatment today

Main concern, where it hurts, how long you’ve had it, and what you’d like from the session

Had massage before? (yes / no)

Preferred pressure (light / medium / firm)

Any areas you’d prefer I avoid

Consent & data protection

I confirm the information above is accurate and complete, and that I’ve shared anything relevant to my treatment. I understand that massage is not a substitute for medical diagnosis or treatment, and that I should see my GP about any health concern. I’m not aware of any reason I shouldn’t be treated, and I’ll tell my therapist before any future session if my health changes, or during the session if anything feels uncomfortable.

Your details are held only to provide your treatment safely and to keep the records your therapist is required to keep. They are kept secure, never sold or shared for marketing without your permission, and you can ask to see, correct or delete them at any time.

I consent to treatment and to my details being held as described above.

Optional: I’m happy to receive occasional news and offers by email.

Signature

Date

If the client is under 18, a parent or guardian should give consent and sign below.

Parent / guardian name (if under 18)

Parent / guardian signature

A worked example

An illustration with made-up details, to show how a completed form reads. (On screen only — printing gives you the clean blank form above.)

Name: Jordan Avery · DOB 14/03/1985
Address: 7 Oak Avenue, Reading, RG1 1AA
Phone / email: 07700 900123 · jordan.avery@example.com
Occupation: Management accountant (desk-based, long screen hours)
GP: Dr Patel, Riverside Medical Centre · 07700 900456
Emergency contact: Alex Avery · 07700 900789
Health: Ticked: taking prescribed medication (mild blood-pressure tablets). No allergies to oils or nuts. No recent surgery. Not pregnant.
Treatment today: Lower-back tightness from running, building up to a half marathon. Has had massage before, prefers firm pressure. Would prefer to avoid deep work directly on the right knee.
Consent: Signed J. Avery · 12/06/2026

Keep these records without the paperwork

On MassageHub the intake form fills itself in. The right questionnaire is sent to each client when they book, their answers land against their record automatically, encrypted at rest, and you can have different forms for different treatments. No clipboards, no re-typing, no lost paper.

Get started free

Common questions

What should a massage intake form ask?

Enough to treat safely, and no more. The essentials are contact and occupation details, GP details for emergencies, and a health history covering anything that affects treatment — heart and circulation, bones and joints, skin, recent surgery, pregnancy and how many weeks, medication, and allergies (especially to oils, lotions or nuts). Then what brought them in, their pressure preference, any areas to avoid, and clear consent. Keep it focused — under GDPR you should only collect information you genuinely need.

Do I need written consent before a massage?

Recorded consent protects both of you, and most insurers expect it. Your form should make clear what the treatment involves and confirm the client agrees to it, having given an accurate health history. Note any areas they’d prefer you avoid. For under-18s or vulnerable adults, follow your professional body’s guidance on consent.

How should I store completed intake forms under GDPR?

Securely, with access limited to you, and only for as long as you need them. A pile of paper forms in an unlocked drawer is a weak point. Filling them in is only half the job — the data has to be kept safely too. MassageHub collects intake responses digitally and stores them encrypted at rest against each client, so they’re protected and easy to find, and you can export or delete them on request.