Massage Therapy Intake Form - Integrative Bodywork & Massage Page 3
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3Integrative Bodywork & Massage
We know that it’s your first time in our clinic and we want to thank you for being here!
We’d like for you to take a minute to answer some questions so we can better customize
your experience with us!
Have you ever had a professional massage before?
Yes
No
What type of massage do you prefer? ______________________________________________
What type of pressure do you prefer?
Light
Medium/Firm
Deep
When was your last massage? _____________________________________________________________
What do you hope to accomplish with this massage? (i.e. relaxation, decrease pain, increase flexibility, etc.)
How often do you get massaged? Once a
week
month
never
How often do you see yourself getting massaged? _____________________________________________
Who referred you? ______________________________________________________________________
Are you aware of the health benefits of regular massage?
Yes
No
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