Massage Client Intake Form

Massage Client Intake Form for the Netherlands

Massage Client Intake Form Template for Netherlands

A comprehensive client intake form designed for massage therapy services in the Netherlands, compliant with Dutch healthcare regulations and GDPR requirements. This document serves as the initial assessment and legal agreement between massage practitioners and their clients, collecting essential health information, treatment preferences, and informed consent. It includes medical history, current health status, treatment goals, and necessary legal disclaimers while adhering to Dutch healthcare privacy standards and professional practice requirements.

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What is a Massage Client Intake Form?

The Massage Client Intake Form is an essential document used in Dutch healthcare and wellness practices to gather crucial information before providing massage therapy services. This form ensures compliance with Dutch healthcare regulations, including the Healthcare Quality, Complaints and Disputes Act (Wkkgz) and GDPR requirements. It serves multiple purposes: collecting client medical history and current health status, documenting informed consent, establishing treatment preferences, and creating a legal record of the client-practitioner relationship. The form must be available in both Dutch and English to accommodate the international nature of Dutch healthcare services, and includes specific provisions for data protection and privacy as required by EU regulations.

What sections should be included in a Massage Client Intake Form?

1. Personal Information: Basic client details including name, contact information, date of birth, emergency contact

2. Medical History: Current and past medical conditions, surgeries, medications, and allergies

3. Current Health Status: Present symptoms, areas of concern, pain levels, and current health conditions

4. Lifestyle Information: Occupation, regular activities, stress levels, and exercise habits that may impact treatment

5. Treatment Preferences: Pressure preferences, areas to focus on or avoid, and specific goals for the massage therapy

6. Informed Consent: Client acknowledgment of risks, benefits, and treatment procedures

7. Privacy Statement: GDPR-compliant statement about data collection, processing, and storage

8. Liability Waiver: Legal disclaimer and client acknowledgment of provided information accuracy

What sections are optional to include in a Massage Client Intake Form?

1. Pregnancy Information: Additional section for pregnant clients including due date, pregnancy-related conditions, and physician approval

2. Sports/Physical Activity: Detailed section for athletes or physically active clients about training routines and specific needs

3. Previous Massage Experience: Section for understanding client's massage history and preferences

4. Insurance Information: For clients seeking insurance coverage or medical referrals

5. COVID-19 Screening: Temporary section for pandemic-related health screening when required by health authorities

What schedules should be included in a Massage Client Intake Form?

1. Treatment Pricing Schedule: List of available massage services and their corresponding prices

2. Cancellation Policy: Detailed policy regarding cancellations, late arrivals, and related fees

3. Body Chart: Anatomical diagram for marking areas of pain, tension, or concern

4. Privacy Policy Details: Complete GDPR-compliant privacy policy and data handling procedures

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents

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Massage Client Consultation Form

A GDPR-compliant massage therapy consultation and consent form for use in the Netherlands, combining client health assessment with legal requirements.

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Generate a Bespoke Document

Download a Standard Massage Client Intake Form

Review your own Massage Client Intake Form

What is a Massage Client Intake Form?

What sections should be included in a Massage Client Intake Form?

What sections are optional to include in a Massage Client Intake Form?

What schedules should be included in a Massage Client Intake Form?

Authors

Alex Denne

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