Clinic Hours
Monday 8am - 6pm Tuesday 8am - 6pm Wednesday 8am - 6pm
Thursday 8am - 6pm Friday 8am - 6pm Saturday 9am - 4pm
(250) 753-6322 330-256 Wallace St. Nanaimo BCBook Now!

So pleased to welcome back Susanne Ross, RMT. We are glad to have her helpful hands February and March!

Form Downloads.

If you’re looking to get a copy of our Massage Therapy Intake Form, you’re in the right place. The PDF download is available below.

Knead RMT Intake Form

Forms on a clipboard.

Things to remember.

It is not mandatory to fill these forms out before coming to your appointment, they’re just here to save time.

If you have any questions or concerns with any of the fields on the form, just leave the area blank and we will go over it in person.

What’s in the form?

Here’s a quick overview of what you can expect of the four-page Massage Therapy Intake Form that you’re about to download.

1 of 4 - General Information

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The first page of the Intake Form asks for general information from you, such as your current contact information and occupation. It also contains our Cancellation Policy disclaimer and asks about your current General Practitioner.

2 of 4 - Health Information

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The second page of the Intake Form asks more personal, health related questions. It queries your main health concerns and expectations for your initial session. The second page also contains details about your medical history and current well-being.

3 of 4 - Systems Review

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The third page of the Intake Form is a general review of your systems. It contains a long list of various ailments managed into different categories – we ask you to go over this list and check any ailments that concern you.

4 of 4 - Consent Form

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The fourth page of the Intake Form contains the consent form. This page must be signed by both the client and the practitioner before any treatment can commence.

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Booking your first appointment? Speed up the intake by filling out our 120kb PDF Document Intake Form and bringing it to your first visit.

  • Tel (250) 753-6322
  • Email
  • Fax (250) 753-6321
  • Clinic 330-256 Wallace Street, Nanaimo BC V9R 5B3

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