If you’re a licensed massage therapist or massage establishment owner in Texas, there’s a rule that applies to every single client, every single session — and it’s one of the most commonly cited violations during TDLR inspections.
It’s called 16 Texas Administrative Code §117.91. And if you’re still using a paper form you printed from the internet, or worse — nothing at all — you may be one inspection away from a disciplinary action.
This guide breaks down exactly what the law requires, what TDLR inspectors actually look for, what happens when practices fall short, and how Texas massage businesses are solving this problem before April 1.
What Is TAC §117.91?
Title 16 of the Texas Administrative Code, Section 117.91, is the rule that governs consultation documents for licensed massage therapists in Texas. It sits within Chapter 117, which covers the full body of massage therapy regulations administered by the Texas Department of Licensing and Regulation (TDLR).
On March 13, 2026, the Texas Commission of Licensing and Regulation formally readopted Chapter 117 in its entirety as part of a required four-year rule review. That means these requirements aren’t going away — they’ve just been reaffirmed.
The rule establishes three situations in which a licensed massage therapist must provide a consultation document to a client:
- Before the client’s first massage therapy session
- Any time the client’s reason for seeking massage therapy changes and any of the information required under §117.91(a)(1)–(3) is modified
- Before each session in which breast massage will be performed, unless written consent was already received on a separate document
Simple enough in theory. But the details of what that consultation document must contain — and who must sign it — is where most practices fall short.
What Must the Consultation Document Include?
Under §117.91(a), the consultation document must include all of the following:
1. The Type of Massage Services or Techniques to Be Used
This isn’t a generic checkbox. The document needs to reflect the actual techniques the therapist plans to use during that specific session — Swedish, deep tissue, trigger point, hot stone, pregnancy massage, and so on. Vague language like “therapeutic massage” doesn’t satisfy the requirement.
2. The Parts of the Body to Be Massaged — Including Contraindications
This section must be specific. TDLR has made clear that language like “may include the following areas” does not meet the standard. The document must state the actual areas to be worked and the areas to be avoided, including any contraindications documented from the client’s health history.
This is the section most directly tied to client safety — and it’s the one that creates the most documentation liability if something goes wrong.
3. A Statement About Breast Draping and Breast Massage Consent
The document must include a statement that the therapist will drape the breasts of all female clients and will not engage in breast massage unless the client provides written consent before each session. If breast massage is not a service you offer, you can simply state it will not be performed.
4. A Statement About Genital Draping
The document must state that draping of the genital area and gluteal cleavage will be used at all times during the session for all clients. No exceptions.
5. A Statement That the Client May End the Session
The document must include language confirming that if the client is uncomfortable for any reason, they may ask the therapist to cease the massage — and that the therapist will end the session. Note: a statement that the therapist will “adjust pressure” does not satisfy this requirement. Ending the session is the specific obligation.
6. A Statement That the Therapist May End the Session
The therapist also has the right to end a session if they feel uncomfortable for any reason. This must be stated explicitly in the document.
7. A Statement About Sexual Contact
The document must state that the therapist must immediately end the session if the client initiates any verbal or physical contact that is sexual in nature.
8. The Signature of Both the Client AND the Therapist
This is the element that catches most practices off guard.
Both signatures are required. Not just the client’s. The therapist must sign the consultation document as well — confirming they have reviewed the information, agreed to the services indicated, and will conduct the session in accordance with what’s documented.
Why the Dual Signature Requirement Matters
The dual-signature requirement isn’t bureaucratic box-checking. It creates a documented, legally defensible record that:
- The therapist reviewed the client’s health history before beginning treatment
- Both parties agreed to the specific services that would be performed
- The session was conducted within those agreed parameters
For insurance purposes, this record is critical. For TDLR inspections, it’s non-negotiable.
TDLR publishes a sanctions guide specifically listing consultation document violations as citable offenses. Penalties range from a letter of reprimand to license suspension depending on the nature and frequency of violations. Establishments found non-compliant during an inspection are typically given 10 days to correct the issue — but repeat violations escalate quickly.
In the context of a liability claim, a consultation document with both signatures is one of the strongest pieces of evidence a therapist or establishment can have. Without it, your exposure is significant.
What TDLR Inspectors Actually Check
TDLR conducts inspections of massage establishments on a regular basis. Inspectors review both physical conditions and documentation practices. When it comes to §117.91 compliance, they are specifically looking for:
- Presence of a consultation document for each client on file
- All required elements included in the document — not just some of them
- Both signatures — client and therapist — on every document
- Updated documents when the client’s treatment goals have changed
- Separate breast massage consent documented when applicable
Inspection results fall into three categories: no corrections needed, corrections needed within 10 days, or violations sent to enforcement. A consultation document violation goes directly on your record and can follow your license through renewals.
The Most Common Compliance Failures
After reviewing the TDLR sanctions documentation and the consultation document checklist, the most frequent compliance failures break down into three categories:
Using a Template That Doesn’t Meet Current Requirements
Many therapists are using consultation forms downloaded from massage therapy associations, schools, or the internet. Some of these are outdated. Some never met the specific requirements of §117.91 in the first place. If your form doesn’t include every one of the seven required elements — including the specific session-ending language — it’s non-compliant regardless of how professional it looks.
Collecting Only the Client Signature
This is the most widespread gap. Most client intake processes are designed around collecting client information and the client’s agreement to treatment. The therapist signature step — which requires the therapist to document the specific techniques and body areas for that session and sign off — is frequently skipped, forgotten, or treated as optional.
It is not optional. It is explicitly required under §117.91(a)(8).
Paper-Based Processes Without Audit Trails
Even practices that are doing everything right on paper face a documentation problem: paper forms can be lost, damaged, misfiled, or disputed. When a TDLR inspector asks to review client consultation documents from the past year, a disorganized filing cabinet is not a compliance posture. And if a client dispute or insurance claim arises, your ability to produce a timestamped, unaltered document with both signatures is what determines your exposure.
How Digital Consultation Documents Solve This
The compliance problem created by §117.91 is fundamentally a workflow problem. Therapists are focused on delivering an excellent session — not on making sure every checkbox in a regulatory requirement is ticked before the client hits the table.
The solution is to remove the compliance burden from the therapist’s checklist entirely and build it into the intake process automatically.
Digital consultation document platforms like OtterSign handle this by:
- Sending the consultation document automatically before the first appointment — no staff action required
- Capturing both the client signature and the therapist countersignature in a single, legally complete document
- Storing every document with a full audit trail — timestamps, IP addresses, signature sequence, and document history
- Flagging when updated documents are needed — such as when treatment goals change
- Making every document instantly retrievable for TDLR inspections, insurance inquiries, or liability review
For practices using MindBody for scheduling, this workflow can be triggered automatically when a new client is added — meaning from the moment a client exists in your system, their §117.91 compliance is already in motion.
What “HIPAA-Aligned” Means for Your Consultation Documents
Your consultation documents contain protected health information. Medications, injuries, medical conditions, contraindications — this is sensitive data, and how it’s stored and transmitted matters.
Many small massage practices don’t realize that storing this information in unencrypted email threads, shared Google Docs, or paper files creates real liability exposure — separate from the TDLR compliance question entirely.
OtterSign is built with HIPAA-aligned security practices across document storage, transmission, and access control, with SOC 2 certification currently in progress. That means your consultation documents are treated with the same security standards that HIPAA requires for protected health information — encrypted at rest and in transit, with access controls and audit logging in place.
For solo therapists and small studios, this level of security is typically out of reach without a dedicated platform. OtterSign makes it the default.
The April 1 Window
With Chapter 117 readopted on March 13, 2026, TDLR has signaled that these requirements are current, enforced, and here to stay. Inspectors are active. Violations are documented. The question for every Texas massage establishment is not whether compliance matters — it’s whether your current process can survive an inspection.
For practices that aren’t yet compliant, the window to get ahead of this is right now.
Getting set up with digital consultation documents takes days, not weeks. And the cost of getting compliant is a fraction of the cost of a single enforcement action — let alone a liability claim where your documentation falls short.
Getting Started
OtterSign is purpose-built for massage therapy operators, wellness studios, and activity-based businesses that need to collect, store, and manage signed documents at scale — with compliance built in, not bolted on.
For Texas massage therapists and establishments, OtterSign handles the full §117.91 consultation document workflow — client-facing intake, therapist countersignature, TDLR-ready audit trail, and MindBody integration for practices already on that platform.
Ready to get compliant before your next inspection?
Start your free trial at ottersign.com or read more on the OtterSign blog.
OtterSign helps Texas massage therapists and wellness operators meet their documentation and compliance obligations — digitally, securely, and without the paperwork.
