Pre-Event Sports Massage Questionnaire

Please Note: This is a fast-paced, upbeat massage designed to be stimulating.

Please let your therapist know if you have any concerns or problems.

Your massage therapist's name is: _________________ Tips for getting more out of your massage:
• Use the restroom before you get on the table.
What is your name? ____________________________ • Continue your warm-up after your massage,
and don't forget to stretch.
Have you ever received a massage before? Yes / No
Do you have any medical problems your therapist should be aware of?
 High Blood Pressure  Diabetes  Infection
 Heart Condition  Varicose Veins  Injury _______________________
 Respiratory Condition  Rash  Other _______________________

What sport(s) do you participate in?_____________________________________________________

Have you warmed up? Yes / No When is your next event? ______________________________
How often do you usually train? ________________________________________________________

Is there anything in particular you would like worked on? Mark problem areas on the diagram below if
you prefer. ________________________________________________________________________
__________________________________________________________________________________
• How long have these areas been problematic? __________________________________________
• How frequently do these problems occur? _____________________________________________
• What movements cause or aggravate the discomfort? ____________________________________
_______________________________________________________________________________
What areas would you like your therapist to avoid?
____________________________________________
____________________________________________
____________________________________________
Please complete this section after your massage:
Do you have any feedback regarding the massage
you just received? ____________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________

/ 2013-12-12