The Massage Clinic of Poplar Bluff
Client Forms

Client Intake Forms

These forms are necessary for a safe and healthy massage session. Your Therapist needs this information to provide the best care possible. If you have access to a computer and printer, please feel free to print them and fill them out at your own convenience. Just don't forget to bring them with you to your appointmentlaughing


These are Adobe reader documents, so make sure you have some version of this installed on your computer to download and print.

Massage Intake Form

Prenatal Massage Intake Form Adobe.pdf



You may occasionally be asked to fill out a form like the one below. This helps us pinpoint areas of acute pain, or chronic issues.

Health Status Update form




These forms can be printed and taken to your Primary Healthcare Provider. 

Working with your Medical professional is important for many reasons. If you have a condition which requires you to be monitored closely, it is wise to consult your Physician before receiving Massage. If you are not sure, call either the Clinic or your Dr.'s office, to obtain more information.

Physician's Permission form
Physician's Referral form

Associated Bodywork & Massage Professionals
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