New Client Intake Form

Welcome to Morgan Massage!

Thank you for scheduling an in-home massage with us. To ensure we can provide the care and relief you’re looking for—whether it’s to recover from pain or simply unwind—please take a moment to complete the New Client Intake Form below. This information helps us understand your specific goals and any concerns.

We take your privacy seriously—everything you share will be kept confidential. If you have any questions, don’t hesitate to get in touch.

See you soon, and we can’t wait to bring relaxation and relief to your door!

New Client Intake Form

Client Information

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Parking and Access Instructions

If applicable, please provide parking availability details (e.g., driveway, street parking) and entry instructions (e.g., gate code, elevator access).

Checkboxes for seeking

Date of Birth *

Gender *FemaleMalePrefer not to say

Massage Therapy Details

In-Home Setup Preferences

Where should the massage table be set up? (e.g., living room, bedroom). Let us know if there are any factors we should consider for your comfort (e.g., pets, lighting, noise level).

Reason for seeking massage therapy: *

Health History *

(medical conditions, injuries, surgeries, allergies, medications, and current symptoms)

Previous massage therapy experience *

Areas of body to focus on *

Areas of body to avoid *

Emergency Contact Name *

Emergency Contact Phone *

Consent and Authorization

Checkboxes *

• I consent to massage therapy treatment and release this organization from all liability

Signature *

Clear Signature

Submit