Massage Therapy Client Intake Form

    Personal Information

    Have you had a professional massage before?

    How long ago?

    Do you have any difficulty lying face down, on your back, or side?

    Please specify

    Do you have any allergies to essential oils, lotions, or ointments?

    Please specify

    Do you have sensitive skin?

    Please specify

    Are there any areas (feet, face, abdomen) you DO NOT want massaged?

    Please specify

    Do you have any orthopedic injuries and/or surgical history within the last 12 months?

    Please specify

    Do you suffer from chronic pain?

    Please specify

    Are you currently taking any medications (blood thinners, blood pressure, pain medication routinely)?

    Please specify


    Please mark any of the following conditions you may currently have. Please list any conditions not listed in the box below.

    Please check the box any specific areas you would like your therapist to concentrate on.

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    Additional Details / List of Medications & Conditions (continued)

    Massage Therapy Aftercare

    Reiki and crystals are both effective healing techniques on their own, but combining the two can help to intensify, focus, and control your healing process.

    Drink plenty of water after your massage to help flush out toxins released during the session and rehydrate the body

    Limit your alcohol and caffeine intake for the rest of the day to help your body fully relax

    Avoid strenuous physical activity, or heavy lifting for a least 24 hours after your massage

    Give your body time to rest and recover following your massage therapy session.

    Use natural moisturizers or massage oils to keep your skin hydrated and avoid using harsh exfoliants i mmediately afterwards

    Schedule your next massage therapy session as recommended by your therapist to maintain the benefits and address any ongoing concerns.