Massage Intake Form | Raleigh Massage

Step Above Massage — Client Intake Form

Please complete this form before your first appointment. It helps us tailor your session safely.

Contact InformationFull Name * Email * Phone * Emergency Contact Name Emergency Contact Phone Occupation

Visit DetailsReason for Visit / Goals for This SessionAreas of Pain, Tension, or InjuryPreferred Pressure Have you had a professional massage before?

Yes No

Health HistoryCurrent Medical ConditionsCurrent Medications / SupplementsAllergies (oils, lotions, latex, etc.)Recent Surgeries or InjuriesAre you currently pregnant?

Yes No N/A

Anything else the therapist should know?

Consent I understand massage therapy is provided for relaxation and/or therapeutic purposes and is not a substitute for medical care. I have disclosed all relevant health information above and consent to receive massage therapy. * Type your full name as your signature *