PAPER SUBMISSION FORMS: Print and fill out these forms to speed up the intake process during your first visit.
ONLINE SUBMISSION OF MASSAGE THERAPY FORM:
- Online Massage Therapy Intake Option – if you do not want to deal with paper.
- If your using your insurance, PIP, or have an L&I Claim, please fill out the Insurance Verification Form as well.
Prescriptions with treatment plans for Massage Therapy are required for all HMA and Regence patients for plans that require authorization. The form below is our prescription for massage therapy. Print it out and take to your Primary Care Provider or Chiropractor for signature. Bring it back to us and we will keep it on file for medical billing:
- Massage Therapy Prescription, Referral, Med. Necessity
Other forms/informational material of interest:
- New Patient Registration ia
- Authorize to Disclose Form
- Notice of Privacy Practices
- Patients Rights and Responsibilities
- What is Cupping Massage Therapy
- Informational Cupping Massage Therapy Brochure
- VIDEO: The Science of Acupuncture BBC Documentary