Massage Client Intake Form

Massage Client Intake Form Template for Philippines

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Key Requirements PROMPT example:

"I need a Massage Client Intake Form for my luxury wellness center opening in Manila in January 2025, with strong privacy protection clauses and sections for premium service preferences, including a detailed liability waiver that covers our specialized treatments."

Document background

The Massage Client Intake Form is an essential document used in Philippine massage therapy and wellness practices to gather crucial client information before providing treatment services. This form serves multiple purposes: it collects necessary medical history and health conditions to ensure safe treatment, documents client preferences and expectations, establishes informed consent, and creates a legal record of the service agreement. Designed to comply with Philippine regulations, including the Data Privacy Act of 2012 and Department of Health guidelines for wellness establishments, this document is crucial for risk management and maintaining professional standards in massage therapy practice. The form should be completed by new clients before their first session and updated periodically to ensure information remains current and accurate.

Suggested Sections

1. Client Personal Information: Basic contact details including name, address, phone, email, emergency contact, and preferred method of contact

2. Medical History: Comprehensive health history including current conditions, medications, surgeries, injuries, and chronic conditions

3. Current Health Status: Present symptoms, areas of concern, pain levels, and specific areas requiring attention

4. Treatment Preferences: Preferred pressure levels, areas to avoid, and specific massage techniques requested or contraindicated

5. Consent and Acknowledgment: Client's agreement to treatment, acknowledgment of risks, and confirmation that provided information is accurate

6. Privacy Notice: Statement on how personal and medical information will be collected, used, and protected in compliance with the Data Privacy Act

7. Liability Waiver: Terms limiting liability and acknowledging inherent risks of massage therapy

Optional Sections

1. Insurance Information: Required only if the establishment accepts health insurance or provides receipts for insurance claims

2. Photo/Video Consent: Optional section for establishments that take before/after photos or use client images for marketing

3. Referral Source: Optional marketing information to track how clients found the establishment

4. Membership Options: Optional section for establishments offering membership or package deals

5. Special Accommodations: Optional section for clients requiring specific arrangements due to disabilities or medical conditions

Suggested Schedules

1. Medical Conditions Checklist: Detailed checklist of common medical conditions and contraindications for massage therapy

2. Body Map: Diagram where clients can mark areas of pain, tension, or areas to avoid

3. Service Menu and Pricing: List of available massage services, durations, and corresponding prices

4. Establishment Policies: Detailed policies regarding cancellations, late arrivals, and payment terms

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Wellness and Spa

Alternative Medicine

Physical Therapy

Sports and Recreation

Hospitality

Medical Tourism

Relevant Teams

Legal

Compliance

Operations

Customer Service

Medical Records

Risk Management

Quality Assurance

Wellness Services

Front Desk

Administration

Relevant Roles

Massage Therapist

Spa Manager

Wellness Center Director

Compliance Officer

Medical Records Administrator

Risk Management Coordinator

Customer Service Manager

Healthcare Administrator

Physical Therapist

Alternative Medicine Practitioner

Quality Assurance Specialist

Operations Manager

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Let's create your Massage Client Intake Form

Authors

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