Q01
Message
All templatesHealthcare & Clinical
Massage Therapy New Client Intake Assessment
A pre-session intake for massage and bodywork clients that captures health history, contraindications, areas of tension, and treatment goals so therapists can plan a safe, effective session. An AI follow-up interview digs into the client's primary concern — onset, triggers, and what's already been tried — so therapists walk in with context instead of a blank form.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
13 questions · ~7 min
Q02
ConsentRequired
Please review and confirm before continuing.
Q03
Multiple ChoiceRequired
What's the main reason for today's massage?
- General relaxation
- Chronic pain relief
- Recovery from a specific injury
- Stress or anxiety reduction
- Sports performance or recovery
- Prenatal comfort
- Improving flexibility or range of motion
Q04
Multiple ChoiceRequired
Which areas are feeling tense, sore, or painful today? Select all that apply.
- Neck
- Shoulders
- Upper back
- Lower back
- Hips or glutes
- Legs
- Arms or hands
- Feet
Q05
MatrixRequired
Do any of the following apply to you right now? This helps us avoid areas or techniques that could be unsafe.
7 rows × 3 columns
- High blood pressure or a heart condition
- Currently pregnant
- Recent surgery or injury (within the last 6 weeks)
- Blood clots or a history of deep vein thrombosis
- Skin conditions, rashes, or open wounds
- +2 more
Columns: Yes · No · Not sure
Q06
Long Text
If you're dealing with a specific pain, injury, or medical condition, describe it here — when it started, what makes it better or worse, and anything your therapist should know.
Q07
Multiple ChoiceRequired
What pressure level do you generally prefer?
- Light, mostly relaxing
- Medium
- Firm
- Deep tissue
- It varies by area — I'll tell my therapist
Q08
Opinion ScaleRequired
How would you rate your overall stress level right now?
Scale: 1 – 10
Min:Very calmMax:Very stressed
Q09
Long Text
List any medications, supplements, or known allergies your therapist should be aware of (or write 'none').
Q10
AI Interview
Focus on the client's main reason for the visit and the area they flagged as most tense or painful: ask when it started, what triggers or worsens it, and what they've already tried (self-care, physical therapy, other treatments) and how well it worked. If they marked 'Not sure' on any health-history item, gently clarify what that means before the appointment. Close by confirming what a successful session would feel like to them.
Q11
Multiple Choice
What's your age range? (Optional — helps us tailor techniques appropriately.)
- Under 18
- 18–29
- 30–44
- 45–59
- 60–74
- 75 or older
- Prefer not to say
Q12
Multiple Choice
How do you describe your gender? (Optional)
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q13
Message
Thank you for sharing this with us! Your therapist will review your intake before your session to plan the safest, most effective approach for you. This information is kept in your confidential client file.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Includes a dedicated AI follow-up interview step that probes the client's flagged main concern and most tense area — onset, triggers, what's been tried — before the therapist ever sees the intake
- Combines structured screening (contraindication matrix, pressure preference, tension-area selection, stress rating) with open-ended health history so therapists get both quick-scan and narrative context
- Optional age/gender demographic questions are clearly marked optional and framed around technique tailoring, not just data collection
- Ends with a clear consent step and a closing message setting expectations that the therapist reviews the intake before the session
Jotform
Massage Therapy Client Intake Form TemplateA standard fielding-ready intake form built on Jotform's drag-and-drop form builder, likely covering health history and consent fields typical of massage intake paperwork. It benefits from Jotform's large template ecosystem and integrations, but reads as a static document-style form rather than an interactive interview.
What it does well
- Ready-to-use template within a mature, widely-used form builder
- Likely supports e-signature and PDF export common to Jotform's healthcare templates
- Large surrounding template library for related intake variants
Where it falls short
- No adaptive follow-up questioning — clients can't be probed further on their stated pain or concern
- No per-response quality scoring or automated report generation for therapists
- No voice-based interview option
Typeform
Massage Therapy Client Intake Form TemplateA conversational, one-question-at-a-time intake form in Typeform's signature style, which likely makes it feel friendlier than a typical medical form. It's a fixed-path template, however — logic branching exists but there is no genuine AI-driven follow-up that adapts based on what the client actually writes.
What it does well
- Polished, conversational UI known for higher completion rates than dense static forms
- Simple logic jumps possible based on multiple-choice answers
- Easy to embed on a therapist's booking site
Where it falls short
- No adaptive AI interview to dig into onset/triggers of a specific complaint
- No automated quality scoring of open-text responses
- No voice AI interview option or auto-generated clinical-style report
SurveySparrow
Massage Therapy Intake Form TemplateA conversational survey template positioned in SurveySparrow's healthcare category, presumably covering health history and preferences in a chat-like format. Like Typeform, its conversational feel is a UX layer over static question logic rather than true adaptive probing of client answers.
What it does well
- Chat-style format designed to feel approachable for a wellness intake
- Sits within a dedicated healthcare template category, suggesting some domain tailoring
- Likely supports basic skip logic
Where it falls short
- No adaptive AI follow-up interview or voice interview option
- No automated per-response quality scoring
- No transparent, published prompt methodology or auto-generated report for the therapist
SurveyMonkey
Client Intake Form TemplateA generic client intake form template, not specifically built for massage or bodywork practices, so a therapist would need to customize it substantially to cover contraindications, tension areas, and pressure preference. It's a static survey suited to broad service businesses rather than a purpose-built massage intake.
What it does well
- Backed by SurveyMonkey's established survey infrastructure and analytics
- Flexible generic structure adaptable across many service businesses
- Familiar builder for teams already using SurveyMonkey
Where it falls short
- Not massage-specific out of the box — lacks built-in contraindication or tension-area screening
- No adaptive AI or voice interview to explore a client's specific complaint
- No automated quality scoring or auto-generated per-client report
Frequently asked questions
What questions are in the “Massage Therapy New Client Intake Assessment” template?
The template includes 13 ready-to-use questions, starting with: “Welcome! Before your massage, we'd like to understand your health history and goals so we can tailor your session safely…” · “Please review and confirm before continuing.” · “What's the main reason for today's massage?”. The full set is previewed above, and every question is editable.
How long does this survey take to complete?
Respondents typically finish the 13 questions in about 7 minutes.
Can I customize this template?
Yes — every question, answer option, and the ordering is editable before you launch. You can add or remove questions, or ask the AI editor to rework the survey around your research goal.
Is this template free to use?
Yes. Open it in the editor and start customizing right away — no account required to try it, and the free plan covers launching your survey.
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.
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