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Massage Client Intake Form

Massage Client Intake Form Template for Indonesia

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Key Requirements PROMPT example:

Massage Client Intake Form

"I need a Massage Client Intake Form for my new luxury spa opening in Jakarta in March 2025, which will cater to both Indonesian and international clients, with extra emphasis on data protection compliance and sophisticated liability coverage."

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Document background
The Massage Client Intake Form is a crucial document used in Indonesian wellness and healthcare settings to gather essential information before providing massage therapy services. It ensures compliance with Indonesian healthcare regulations, particularly Law No. 36 of 2009 on Health and the 2022 Personal Data Protection Law. This form should be used before the first massage therapy session and updated periodically to maintain accurate client records. It includes comprehensive health screening, consent documentation, and privacy notices, protecting both the client and practitioner while facilitating appropriate treatment planning. The form is designed to meet both legal requirements and practical needs of massage therapy practices in Indonesia, whether in standalone clinics, spas, or healthcare facilities.
Suggested Sections

1. Personal Information: Basic client details including name, date of birth, contact information, occupation, and emergency contact details

2. Medical History: Comprehensive health history including current medications, surgeries, chronic conditions, and ongoing treatments

3. Current Health Status: Present health conditions, areas of pain/discomfort, stress levels, and current symptoms

4. Treatment Preferences: Preferred pressure levels, areas to focus on or avoid, and specific massage goals

5. Informed Consent: Client acknowledgment of risks, benefits, and understanding of massage therapy procedures

6. Privacy Policy: Information about how personal data will be collected, stored, and protected in accordance with Indonesian PDP Law

7. Liability Waiver: Legal disclaimer and client assumption of risks associated with massage therapy

Optional Sections

1. Pregnancy Information: Additional section for pregnant clients including trimester, due date, and pregnancy-specific health concerns

2. Sports/Exercise History: For clients seeking sports massage or with active lifestyle, detailing physical activities and related injuries

3. Previous Massage Experience: Optional section about past massage experiences and preferences

4. Payment and Cancellation Policy: Terms for payment, cancellation, and rescheduling if the establishment has specific policies

5. Photo Consent: Optional authorization for taking before/after photos for treatment tracking purposes

Suggested Schedules

1. Body Chart: Diagram where clients can mark areas of pain, tension, or areas to avoid

2. Contraindications List: Detailed list of conditions that may prevent massage or require medical clearance

3. Service Menu: List of available massage types and duration options

4. Aftercare Instructions: Post-massage care guidelines and recommendations

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Linkedin in social icon imageX social icon image
alex.den.21@genieai.co
Relevant Industries

Healthcare

Wellness and Spa

Beauty and Personal Care

Sports and Recreation

Hospitality

Medical Tourism

Alternative Medicine

Relevant Teams

Operations

Wellness Services

Customer Relations

Compliance and Legal

Quality Assurance

Medical Records

Front Desk

Risk Management

Health and Safety

Relevant Roles

Massage Therapist

Spa Manager

Wellness Director

Healthcare Administrator

Compliance Officer

Risk Management Specialist

Customer Service Representative

Medical Records Coordinator

Spa Receptionist

Quality Assurance Manager

Traditional Medicine Practitioner

Industries
Law No. 36 of 2009 on Health: Indonesia's primary health law that governs all health-related services, including traditional and complementary medicine like massage therapy
Law No. 27 of 2022 on Personal Data Protection (PDP Law): Regulates the collection, processing, and storage of personal data, including sensitive health information collected in intake forms
Law No. 8 of 1999 on Consumer Protection: Ensures consumer rights and business obligations in service provision, including transparency and safety in massage services
Minister of Health Regulation No. 61 of 2016: Regulates traditional health services including traditional massage, setting standards for practice and documentation
Regional Business Licensing Regulations (Perda): Local government regulations regarding business permits and operational standards for massage and wellness services
Minister of Health Regulation No. 269/MENKES/PER/III/2008: Regulates medical record keeping and documentation requirements, which applies to health-related service providers
Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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