Forms

To save some time at your first visit, print out the INTAKE form and bring it with you! I also have them on-hand if you do not have access to a printer. Come in a few minutes before you first appointment to fill this out!

If you have been in a motor vehicle accident, please print out ALL forms below. You MUST have the prescription form filled out by your physician or chiropractor to have massage services paid through your claim. 

 

Intake Form

General information and consent for treatment

Prescription Form

This needs to be filled out by your physician or a chiropractor when using an insurance claim.

Record Release

This form is so that I may have access to your medical file to create a treatment plan for your insurance claim.

Attorney Protection Form

If your accident is in litigation, your attorney will pay for services rendered at the time of case settlement.

Assignments of Benefits

Release of records, payment agreement and assignment of benefits

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