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

Varicose Veins

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