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Therapist / Practice Information

Therapist Information

Entity Type Individual Person Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Trust Non-Profit Organization Government Entity

Select the type of entity

Full Legal Name

As it should appear on the document

Doing Business As (DBA)

Optional trade name

State of Formation Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

Where the entity was formed

Authorized Representative

Person authorized to sign

Representative Title

Title or position

Address

Street Address

Full street address including suite or unit number.

City

City of therapist residence or business.

State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

State where this address is located.

ZIP Code

5-digit ZIP code.

Email Address

Used for correspondence and notices.

Phone Number

Best number for direct contact.

Client Information

Client Information

Entity Type Individual Person Corporation Limited Liability Company (LLC) Partnership Sole Proprietorship Trust Non-Profit Organization Government Entity

Select the type of entity

Full Legal Name

As it should appear on the document

Doing Business As (DBA)

Optional trade name

State of Formation Select state... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

Where the entity was formed

Authorized Representative

Person authorized to sign

Representative Title

Title or position

Address

Street Address

Full street address including suite or unit number.

City

City of client residence or business.

State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming District of Columbia

State where this address is located.

ZIP Code

5-digit ZIP code.

Email Address

Used for correspondence and notices.

Phone Number

Best number for direct contact.

Service & Consent Terms

Session Type / Duration * Select… Swedish Massage — 60 minutes Swedish Massage — 90 minutes Deep Tissue — 60 minutes Deep Tissue — 90 minutes Sports Massage — 60 minutes Prenatal Massage — 60 minutes Hot Stone Massage — 90 minutes Custom / Package (see agreement)

Specify the service type and duration. This determines rate, draping standards, and any special certification requirements (prenatal, medical massage).

Session Rate ($) *

The rate per session. Specify whether gratuity is included. Package pricing should note the per-session rate and total value for comparison.

Cancellation / No-Show Policy 24-hour notice required; full fee charged for no-show 48-hour notice required 50% fee for late cancellation (under 24 hours) No cancellation fee

A 24-hour cancellation policy is industry standard. Late cancellations prevent the therapist from filling the slot. Clearly communicate the policy at booking.

Therapist License Number

Most states require massage therapists to hold a current LMT license. Including the license number on intake forms provides client assurance and regulatory compliance.

Health Conditions Client Should Disclose

A health intake process protects both the client and the therapist. Proceeding with massage on contraindicated conditions can cause harm and create liability.

Informed Consent Statement Client acknowledges informed consent to receive massage therapy Informed consent documented on separate health intake form

Informed consent is legally and ethically required before massage therapy. It confirms the client understands the nature of the service and voluntarily agrees to receive it.

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Not Legal Advice: This automated form assistance tool provides general information and document templates. It is not a substitute for legal advice from a qualified attorney. Laws vary by jurisdiction and change over time. Consult with a licensed attorney for advice specific to your situation.
Last updated: January 2026