New Client Intake Form for Bodyworks

Thank you for booking with Bodyworks Massage Therapy. As a new client it’s important that we learn a little more about you and how we can help, so we’d appreciate if you could fill out our Client Intake Form below before your appointment. Once you complete the form, there’s no need to arrive early, just arrive at your scheduled time.


Client Intake Form

Contact details

Mobile Ph:
Home Ph:
Work Ph:
Date of Birth:
Occupation/Main work:  

How did you hear about us?
If someone referred you, who was it?

What sport/exercise do you do and how often?:

If you are wanting pure relaxation massage from us, then you can skip the next section and go to the bottom of the page, however you might like to complete the next section so we know where to focus.

Present Problem/Condition

What is your current main problem or condition and where?
Is it getting progressively worse?
Yes No Comes & goes
Rate your current pain/discomfort level.
0 = no pain, 10 = worst pain you can imagine
What aggravates your condition?
What have you done to get any relief?
Has it been medically diagnosed? If yes, by whom and what was the diagnosis?
Have you had any surgery? List as many as you can remember with the approx. year
Have you had any accidents or injuries? List as many as you can remember with the approx. year

 We'd like to be able to contact you occasionally with information regarding massage therapy and general healthcare, as well as special promotions related to our business.  Please tick ONLY IF YOU DON'T WANT to receive this information. Your information will not be shared with any other company and you can update it at any time by contacting us at . We respect your privacy under the Privacy Act 2020.