Client or patient? What the word decides in your session notes

The session is over, and you sit down to write the note. Before the first line, you already have a word for the person who just left: client, or patient. Do massage therapists have patients or clients — and does it matter which?

In the US, practitioners who work outside a clinic say client. And it matters more than it seems: the word you pick shapes what you end up writing.

Do massage therapists have patients or clients?

In the US, clients, unless a doctor is part of the work. Practitioners say “patient” when they work under a doctor, bill insurance or work with a hospice team. Even state rules do not use the same word.

Practitioners on Reddit are clear about it. The top reply in one thread says: “It is never appropriate to call a client a patient unless you are working under the supervision of a doctor…” (a practitioner in r/MassageTherapists, 2024). A commenter in another thread puts it more simply: “Doctors have patients. Massage Therapist, Physical Therapist, Wellness Practitioners in general, have clients” (a commenter in r/massage, 2022).

When practitioners do say “patient”, it is because of where they work. One works in a chiropractor’s office and writes “patient” in that office’s notes, but says “I revert back to “client” when I’m not at work” (r/MassageTherapists, 2024). A music therapist in hospice uses the word “only in my documentation or when I’m talking to the team” (r/massage, 2022).

The country matters too: some practitioners in Ontario say they were taught to say “patients” (r/MassageTherapists, 2024). So the word depends on the setting, not on the person.

State rules differ as well. New York’s practice guidelines write “patient/client” throughout, down to “patient/client records” (New York State Education Department, retrieved 2026). Georgia’s rules say client, for example consent “signed by the client” (Georgia Board of Massage Therapy, Rule 345-6-.01, retrieved 2026).

For a firm answer, read your own state’s practice act. This article is not legal advice.

What does each word promise?

A “patient” has a condition, and someone else is in charge of fixing it. A “client” came on their own and decides what the session is for. The word tells you who leads.

The word “patient” comes from the Latin for to suffer. Its first meaning is “an individual awaiting or under medical care and treatment” (Merriam-Webster, retrieved 2026). The dictionary also has a softer meaning: someone who receives a personal service.

But in everyday use, “patient” means a clinic. When you use the word, the clinic comes into your notes with it.

A “client” is “a person who engages the professional advice or services of another” (Merriam-Webster, retrieved 2026). The person chooses you, and they decide where the work goes.

One practitioner links this to the limits of the job: “In the US, scope of practice is our protection. We recommend (we do not "prescribe" or "treat")…” (r/MassageTherapists, 2024). “Client” fits inside those limits.

In my own practice, the difference is about who is in charge. A patient hands control to the doctor and waits.

A client stays a partner: we work toward the same goal. People get used to seeing their situation from the inside, the only way they have looked at it for years. My part is to help them step outside it for a moment. From there, they can see that the pattern is not who they are.

How does the word change what you write?

The word you have in mind decides what the note looks like. “Patient” asks for findings, a named condition and a plan. “Client” asks for what you saw and what the person said.

When advice for therapists talks about records, it treats the word as a label. One article says: “Whichever term you settle on, it should be the one your records use consistently” (Gardner, 2026). Another says that whether you write “patient” or “client”, “your notes stay clear and compliant” (Headway, 2025).

In my experience, the word changes more than the label. It changes what you write.

Look at what a rule asks for once there is a health condition. Washington adds four items to the record only “For massage therapy where the focus is on treating a health condition”: symptoms, “Evaluation and findings”, “Outcome measures” and a “Treatment plan for future sessions” (WAC 246-830-565, 2021).

These are the fields of the “patient” frame: a condition, a finding, a plan. If you have no condition to name, those fields stay empty or fill up with guesses. If you work outside Washington, this rule does not apply to you.

The “client” frame asks for things you can actually write: what the person came with, in their own words; what you did; what you noticed; what they said and decided. For the full list of what goes into a note like this, see session notes without the clinic. Here is the same thought written both ways, the way I write my notes:

About the second row: there are no tests in my work. There is pattern recognition, and there are small experiments. Sometimes a person tenses up instead of saying they don’t like something, and that tells you a lot. It goes into the note as something that happened, not as a finding.

Which format to use — SOAP, CARE or plain paragraphs — is a separate question. First choose the frame. You can do it before your next note.

Who picks the word?

Usually you do. People rarely arrive with a word for themselves. You choose it when you write the first line, and the frame comes with it.

In my practice, nobody calls themselves a “patient”, except as a joke. So I choose the word, and the word decides what the session is about: a condition to fix, or a person to work with.

Even the building does not decide it. I once went to an acupuncture clinic where the staff called people clients. A person lying there with needles in was still a client.

Sometimes a person picks a word for you. A new practitioner wrote that colleagues with decades in holistic care say “patients”, and that being called “doctor” by clients made them uneasy (r/MassageTherapists, 2024).

The replies were clear: “if a client calls you a doctor you have an obligation to correct them” (r/MassageTherapists, 2024). You can correct someone kindly. One practitioner says: “I always correct them and graciously insist that they do not call me "doctor"” (r/MassageTherapists, 2024).

Something to do tonight: open the last three notes you wrote. Mark every word that belongs to a chart, like finding, condition or plan. You don’t have to change anything yet. Just notice whose language you have been using.

Where do notes like this live?

Anywhere you can write in your own words and find the note again before the next session. We built ours around the word client.

HoldSpace is practice management for holistic practitioners — voice-first session notes, online booking, and client history in one place, built for people who hold space, not for hospitals.

The people you work with are clients on every screen. You dictate the note after the session, and your speech is saved as text, not as audio.

Structuring rewrites the note into clear sections without changing what you meant. Your original text is kept too.

To see how it looks, read why we built HoldSpace. If you do bodywork, see the page for bodyworkers.

Next time you sit down after a session, you will already have your word. Start the note with what the person told you, and end it with what comes next. That is where your next session will begin.

Write the note in your own wordsFree plan: 30 minutes of voice, 10 structurings and 5 clients.

FAQ

Why do practitioners say client instead of patient?

Because “patient” brings a condition and someone in charge of fixing it, and outside a clinic neither is there. A client is “a person who engages the professional advice or services of another” (Merriam-Webster, retrieved 2026): they came to you, and they decide what for. The codes of ethics of AMTA and ABMP both use client (AMTA Code of Ethics, 2010; ABMP Code of Ethics, retrieved 2026).

Is it ever right to say patient?

Yes, when the setting makes it true: under a doctor’s supervision, with insurance, in a clinic, rehab or hospice. One practitioner uses the word only for that building: “They’re still just clients to me, but they’re patients of that office” (r/MassageTherapists, 2024). The choice depends on you and on where you work.

Client, patient or customer?

A customer is “one that purchases a commodity or service” (Merriam-Webster, retrieved 2026). That word is only about buying.

“Client” adds that the person comes for your judgment, not just your time. “Patient” adds a condition and someone responsible for it. For one-to-one work outside a clinic, “client” describes what happens and claims nothing more.