PDF Forms for different massage sessions

Intake Form Press on a BLUE link which will take you to the INTAKE form. This form designed to fill out online only for your safety based on HIPAA requirements.

All patients must fill out an Intake Form by the law in the United States. This is information that will help us give you the best and safest service we can.

It is important, to be honest on this form. All information is strictly confidential.There are some conditions that can be adversely affected by massage.

 

Physician Referral/Prescription Form

Physician Referral/Prescription Form from Authentic Massage Therapy LLC

Confidential Client Intake Form CMS 1500

Authorizing the release of information to the insurance company for billing reasons.

Authorization for Disclosure of Health Information/non prescribed massage therapy clients.

This form needs to be signed by a client if he or she needs to release any information for court, doctors or insurance representatives from Authentic Massage Therapy LLC office.

Pain Assessment Form

This form will help us to save your time and help us to better understand where and how intense your pain.

Prenatal Massage Release Form

This form will help us to provide safe Prenatal Massage Therapy session. Please print this form, sign and bring to your massage session.

Hot Stone Massage Release Form

If you scheduled for Hot Stone Therapy session you need to print and sign this form prior to your appointment.

Minor Release Form

All persons under the age of 18 are required to have a parent or guardian fill out this form.

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