Massage Therapy Consent Form

Get informed consent from clients before each massage, along with their emergency contact and relevant health background. Useful for massage centers and therapists who want to work safely and keep a signed record.

Use this template

In the Claude connectors directory

Name

First Name

Last Name

Age

Date of birth

Email

Phone number

Address

Street Address

City

State / Province

ZIP / Postal Code

Emergency contact

Emergency contact name

First Name

Last Name

Emergency contact phone

Relationship

Do you have any allergies?

Are you currently taking any medication?

Are you pregnant or breastfeeding?

Have you been hospitalized recently?

Do you have any current injuries?

Current medical conditions (asthma, diabetes, heart or kidney problems, epilepsy, scoliosis, contagious illness, etc.)

Painful areas

I, the undersigned, agree to the following:

The information I provided is true and complete I understand the possible effects and risks of massage I understand massage does not replace medical care I will tell the therapist if I feel discomfort during the session I consent to receive the treatment

Client signature

Sign here

Date signed

Related templates

Browse all consent templates →