Chair Massage Encounter Note (On-site Event)

Date of Service: [Date]

Time: [Start-end or total duration]

Location/Event: [Event name and site]

Client Name: [Full name]

Client Age or DOB: [Age or DOB]

Therapist: [Name, credentials, license # if applicable]

Late Entry: [Entry date/time] (Include only if documentation occurs after the date of service; otherwise omit this line.)

Consent & Screening

Consent: [Yes / No] [Written / Electronic / Verbal] (Document that the client understands clothed chair massage, areas to be treated, and the right to stop at any time. Do not infer consent from participation.)

Areas Permitted / Boundaries: [Areas consented to; any areas to avoid and reason]

Screening Outcome: [Cleared for massage / Cleared with modifications / Not treated - deferred]

Screening Details: [Relevant findings, modifications, or deferral rationale] (If a screening concern is identified—such as fever, acute illness, contagious skin condition, open wounds in treatment area, known blood clot risk, recent surgery, or severe pain—document the concern and resulting modification or deferral. Record explicit responses; do not assume "no contraindications" from silence. Omit if cleared without modification.)

Session Notes

Client Request: [Client's stated goal or area of concern in 1-2 sentences]

Treatment: [Areas treated; technique categories; pressure level; total duration] (Document techniques at category level—e.g., compression, effleurage, stretching.)

Response: [Tolerance; client-reported change; therapist observations] (If no adverse effects, state "No adverse response." If adverse effects occurred—such as soreness, dizziness, emotional distress, or skin reaction—document what happened and actions taken.)

Plan

[Self-care guidance, follow-up recommendations, or referral to medical care with reason] (Include only if recommendations were given. If none, state "No follow-up recommendations" or "Event-based session; no ongoing plan.")

Incident Documentation

(Include this section only if a safety event occurred—e.g., fall, injury, allergic reaction, or client complaint.)

• [What happened and when]
• [What was observed vs. reported by client]
• [Immediate actions taken and client disposition]
• [Whether incident report completed and supervisor notified]

(Document facts objectively without assigning fault.)

Signature

Therapist Signature: [Signature or authenticated electronic signature]

Date/Time Signed: [Date and time]

(For corrections or amendments made after signing, preserve the original content and add an amendment with date, time, and reason.)