Medical Intake Form

  • Names
  • Basic Info
  • Habits
  • Health
  • Customize your massage
  • Consent

Medical intake form

For Spa Mobile's Clients who booked an in-home massage.


Name of the person who took the appointment.

It is helpful to know which appointment is associated with you. 

There is no need to add a name if you booked for yourself.


Your basic information

Some description about this section

Day-to-day Habits

This will help us know your day-to-day postures based on work and habits.


Health Form

This information will help us understand your health conditions if there are any risks to receiving a massage.


Special Requirements

Help us customize your massage with those questions.


Light Pressure Very Deep

Consent and Waiver