Without this form, anything you might try to withhold from the security deposit could be disputed. The tenant will say, "It was like that when we moved in." By law, they have 15 days to find things that are broken. Most tenants can return the form the day after move-in.
Please note that this form is part of the Massachusetts Security Deposit law, one of the most expensive laws to mess up. Landlords can be fined triple damages for certain infractions.
The law requires the first paragraph be in 12 point bold-faced font (Section 2c of the law). So you can switch from Arial to Times New Roman if you like, but don't change the font size, and don't you dare unbold it.