Join our WikiEducator discussion group or Register now for free skills training

From WikiEducator

Aims

This learning module aims to help you design and create a client intake form which you can use in your practice.

Purpose of a client intake form

Client intake forms are used to gather important client-specific information prior to treatment. This information typically falls into several categories

• Contact information (Name, address, phone, email)
• Marketing information (Demographic profile, why they came to you, etc.)
• Medical conditions (Generally conditions for which massage is contraindicated)
• Medications
• Life-style descriptors (Employment, Sporting Activities, Other)
• Agreement to terms and conditions

What information do you want to gather ?

Before you can create your own client intake form, you need to decide exactly what information you want to gather. The following exercise is designed to help you do that.

• Review several medical screening forms

• Client intake form listed on page 113 of Chapter 3 (Fritz, 2004)
• University of Kentucky's Professional Health Break Screening Form
• Healthy Impressions Worksite Massage Therapy Program Registration Form
• Otago Polytechnic's Client Details form

• Consider

• Which information is most important for you to gather?
• Do you need a terms and conditions form?

Create your client intake form

Assessment Task 1 for this course requires you to create your own medical screening forms, and to record a number of treatments using these forms, so you really need to get started now on the creation of your form.

Remember that although you can model your client intake form on one or several of the intake forms that you’ve seen, your client intake form should be significantly different to any of the forms that you’ve referred to in this process.

The operate a wordprocessor learning module is available to help support you in this task if you need it.

Refinement of your client intake form

You have just created the first edition of your client intake form. As you progress in your understanding, and as you experience using this form you will notice things about the design of the form that are not ideal. It’s advisable to review and update your client details form on a regular basis for this reason.

References

Fritz, S. (2004). Mosby’s fundamentals of therapeutic massage (3rd ed.). Missouri: Mosby.