Client Interview
Hi, my name is _____ ; I am your student of massage therapy.
The purpose of this interview is to gather your health history accurately so that I may design an appropriate and safe treatment plan for you.
Everything concerning this interview will be confidential in accordance with by-laws and may only be passed on to another health professional with your written consent.
Please let me know if there are any changes in your health condition at any time and I will ensure that your file is updated every year.
If you are uncomfortable with any questions, you don’t need to answer.
Do you have questions before we start?
Is all the information recently?
I see your ______ missing, would you please fill it in?
For your safety, I want to confirm that you don’t have any high blood pressure or heart condition that may contraindicate the massage treatment.
Do you have any allergies to massage oil or any sensitivity to hot and cold temperature change?
Your chief complaint is _____, is this correct?
Can you tell me when this start?
What cause this pain, an accident or something general?
What did you do for this pain?
Do you have the same pain now?
Can you point to the location of your pain?
Is this the constant pain or comes and goes?
Can you scale the pain for me from 0-10, 0 means no pain, 10 means the worst pain. Please scale the first day, the second day and today.
Can you describe the pain for me? Like the dull pain or sharp pain? or shooting
Does the pain radiate anywhere?
Does anything you do can decrease the pain?
Does anything you do can make the pain getting worse?
Has the pain limited your daily activities?
Has the pain affected your sleeping pattern?
Besides the pain, do you have any other accompanying sign, like nausea, vomiting, numbness, dizziness, vision problem…?
What have you done so far for this pain?
Have you seen a medical professional for this pain?
What do you think maybe causing this pain?
Do you have any secondary health condition?
When did it start?
What do you do for that?
Is it under control?
Are you taking any medications?
What type and what is the reason for using this?
How much and how often?
When was the last time you took this?
Do you have any other reason to take this medicine?
We are almost done here.
Is there anything else you’d like to tell me?
What do you want me to focus on this treatment?
What is your goal in trying the massage therapy?
Do you have any questions before we finish this interview?
Thank you.