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: _________________
What is your name? ____________________________
Have you ever received a massage before?

Yes / No

Tips for getting more out of your massage:
• Use the restroom before you get on the table.
• Continue your warm-up after your massage,
and don't forget to stretch.

Do you have any medical problems your therapist should be aware of?


High Blood Pressure
Heart Condition
Respiratory Condition



Diabetes
Varicose Veins
Rash



Infection
Injury _______________________
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