The completion of the massage intake form is one of the most important steps in the practice of Massage Therapy. This is where your therapist gets the information that they need in order to properly assess your physical health as well as understand possible conditions underlying the your chief complaint. It will help your massage therapist to properly formulate a proper treatment plan for you.
How a Massage Intake Form is Delivered
When you book an appointment at ISLA, if it was done online or booked online for you, you will be receiving an intake form digitally on your email. A link will be on that email and you will be asked to put in the requested information. As this is part of proper client care, if you do not provide the required information, you will not be able to book an appointment. If you prefer a paper intake form, you can request this from your therapist. This information will be filed by your therapist and will be kept confidential. The digital intake form will be on an online vault and your paper forms will be in a locked client file. You will be required to fill up or update your client intake form if your chief complaint or treatment goals change.
Required information for a Massage Intake Form
- Your complete legal name
- Your phone number and email address
- Your current legal address
- Your Date of Birth (this is a requirement if you are doing insurance claims or direct billing insurance)
- Your Gender
- Your chief complaint (What is your therapeutic goal – this is the concern that you want addressed such as pain management, reducing muscle tightness, increasing strength, improving range of motion, etc.)
- Your medical history (This is very important as it provides a framework with which your therapist can determine if there are any contraindications and/or modifications to your massage treatment. You have to be honest and declare any medical issues or any clinical diagnosis made by a medical professional for you).
- Any trauma related medical issue – such as an accident or an injury, including how long ago the trauma happened
- Any diagnosis made by a medical doctor.
- Any family history (to indicate whether your concern is a genetic condition)
- Any previous similar concern from the past (to indicate if it is a recurring condition or a chronic one)
- Aggravating factors (these are things that you do that makes the condition worse)
- Relieving factors (these are things that you do the alleviate or reduce the symptoms of the condition – this can be a particular body position, activity or rest)
- Medications taken addressing chief concern (some medications may have some contraindications that does not allow certain massage treatments/modalities)
- Any reactions to previous massage treatments (to avoid repeating this during your treatment)
- Any sensitivities or allergies
- Any medical emergency responses (such as an epi-pen, an asthma inhaler or medication that you may be required to have if certain emergencies arise)
- Pain scale
- Location of pain
- Characteristics and Description of the pain
- Signature indicating your consent for the collection of information.
Other information on a Massage Intake form
- Medical doctor information (required if your massage treatment is being managed by a medical team and information about your massage treatment is required to be shared)
- Emergency Contact – for any emergency situations in which there is a need to contact a person to make them aware of your health condition
- Occupation – shows to the massage therapist whether the concern is due to overuse or if it job – related such as if you are a truck driver, you will be spending a lot of time seated in your cab which can wreak havoc on your lumbosacral region which leads to low back pain.
- Hobbies and Daily Activities – your hobbies and activities can indicate the root cause of the issue. For example if you are miniature model hobbyist, you might be spending a lot of time with your shoulder hunched and your head down which maybe the reason why you have neck and/or shoulder pain.
Massage Intake Privacy and Confidentiality
Privacy and confidentiality are essential components of the massage therapy process, and they are typically emphasized in the massage intake form. Massage therapists are trained to handle your personal and health-related information with care and professionalism. Here’s how privacy and confidentiality are typically addressed in the intake form:
1. Confidentiality Statement
Most intake forms will include a confidentiality statement that assures clients their personal and health information will not be shared with anyone outside the massage practice without their explicit consent. This typically includes:
- Personal Information: Your name, contact details, and any other demographic information will be kept private.
- Health History: Information about injuries, conditions, medications, and any other health details you provide will be protected.
- Treatment Details: Any specific areas of discomfort, massage preferences, or treatment plans discussed during the session will be kept confidential.
2. How Information is Stored
- Secure Storage: Massage practices are required to store intake forms and health information in a secure way (either in physical files in a locked space or digitally with password protection) to prevent unauthorized access.
- Retention Period: In Alberta, your information is retained for a period of 10 years after the last appointment for health and legal reasons but may be destroyed or anonymized after that period.
Massage therapists are bound by ethical guidelines, which emphasize maintaining client privacy and confidentiality at all times. Therapists are trained to keep any details about your physical and emotional state during a session in confidence.