New Client Intake Forms
- Intake Form (Adobe PDF)
- HIPAA Disclosure (Adobe PDF)
- SMS Consent Form (Adobe PDF)
- Cancelation Policy Agreement (Adobe PDF)
Include the following:
- Claim Number & Policy Number
- Referral from Your Physician or Prescription for Massage Therapy
- Diagnosis Code
- Date of Injury
This information must be collected before we can begin your medical massage treatment.
- Contractual Guarantee of Payments Form (Adobe PDF)
Clinical Massage Therapy provides direct billing as a courtesy. We do not guarantee payment by filing insurance claims on your behalf. Insurance is an agreement between you and your insurance company. The financial responsibility for your massage sessions is yours. Coverage eligibility for medical massage should be verified by you prior to receiving services. Please understand massage therapy services or insurance filing is completely separate from any services or insurance filing provided by your physicians or chiropractor.