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Intake Form For Massage Therapy

Intake Form For Massage Therapy Template for New Zealand

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Key Requirements PROMPT example:

Intake Form For Massage Therapy

"I need a comprehensive Massage Therapy Intake Form for my mobile massage therapy business launching in March 2025, with emphasis on home-visit safety protocols and specific sections for elderly clients and those with mobility issues."

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Document background
The Intake Form For Massage Therapy is a crucial document required before commencing any massage therapy treatment in New Zealand. It serves as the primary tool for collecting client health information, documenting medical history, and obtaining informed consent for treatment. The form ensures compliance with New Zealand's healthcare regulations, including the Health Information Privacy Code 2020 and the Health and Safety at Work Act 2015. It helps massage therapists assess contraindications, plan appropriate treatments, and maintain proper clinical records. This document is particularly important in the context of New Zealand's healthcare system, where therapeutic services must meet specific professional standards and may interface with ACC claims for accident-related treatments.
Suggested Sections

1. Personal Information: Client's basic details including name, date of birth, contact information, occupation, and emergency contact details

2. Medical History: Current and past medical conditions, surgeries, injuries, and ongoing health concerns

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

4. Lifestyle Information: Exercise habits, stress levels, daily activities that may impact treatment

5. Treatment Preferences: Pressure preferences, areas to focus on or avoid, specific goals for the massage therapy

6. Consent and Acknowledgment: Client's consent for treatment, acknowledgment of risks, and agreement to policies

7. Privacy Statement: Information about how personal and health data will be collected, used, and protected in accordance with NZ Privacy Act 2020

Optional Sections

1. Pregnancy Information: Additional health information specific to pregnant clients, including weeks of gestation and pregnancy-related conditions

2. Sports/Injury Specific: Detailed information about sports activities, injuries, and rehabilitation goals for sports massage clients

3. ACC Claim Information: Details of ACC claim if the treatment is related to an accident or injury covered by ACC

4. Cultural Considerations: Specific cultural preferences or considerations that may affect treatment

5. Remote Consultation: Additional information required for telehealth consultations or remote assessments

Suggested Schedules

1. Body Chart: Diagram for marking areas of pain, tension, or specific concern

2. Treatment History Log: Record of previous treatments, outcomes, and client progress

3. Informed Consent Details: Detailed explanation of risks, benefits, and treatment protocols

4. Privacy Policy: Detailed privacy policy and information handling procedures

5. Cancellation Policy: Terms and conditions regarding cancellations and missed appointments

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 Personal Care

Sports and Recreation

Alternative Medicine

Medical Services

Rehabilitation Services

Spa and Leisure

Relevant Teams

Operations

Clinical Services

Administration

Compliance

Medical Records

Front Desk

Health and Safety

Customer Service

Quality Assurance

Relevant Roles

Massage Therapist

Physical Therapist

Healthcare Administrator

Clinical Manager

Wellness Director

Practice Manager

Compliance Officer

Medical Records Coordinator

Reception Coordinator

Health and Safety Manager

Industries
Health Information Privacy Code 2020: Governs the collection, use, storage and disclosure of health information, ensuring patient privacy and confidentiality in healthcare settings
Privacy Act 2020: Establishes general privacy principles for collecting and handling personal information, including health-related data
Health and Safety at Work Act 2015: Sets requirements for maintaining safe workplace practices and managing risks in healthcare settings
Health Practitioners Competence Assurance Act 2003: Ensures the competence of health practitioners and protects public health and safety
Consumer Guarantees Act 1993: Provides guarantees for the supply of services, including professional healthcare services
Code of Health and Disability Services Consumers' Rights: Establishes the rights of consumers and duties of healthcare providers in New Zealand
Health (Retention of Health Information) Regulations 1996: Specifies requirements for maintaining and storing health records and information
Contract and Commercial Law Act 2017: Governs the formation and enforcement of contracts, including service agreements in healthcare
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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