Medical Massage Forms
If you have a physician's prescription for massage, you must first contact us via telephone to give us your basic insurance information. Please have the information on the initial client questionnare ready when you call. We will then contact your insurance company. Upon verification of coverage we will contact you to set up an appointment.
Please do not fill out the forms below until after we have contacted you concerning your insurance coverage.
Before your initial visit and consultation you will need to fill out the following forms. You can submit them online (coming soon), print them out and bring them with you, or you can arrive 20 minutes early to fill them out before your initial visit.
- Auto Injury Questionnaire (If you were injured in an auto accident)
- Work Injury Questionnaire (If you were injured at work)
- Confidential Case History Questionnaire (Health History 4c)
- Insurance Billing Fee Schedule
- Assignment of Benefits/Release of Records/Payment Agreement
|
