Intake Form

When this form is successfully completed, the page should refresh to show you a “Form successfully submitted” note. Complete this form before your first appointment. Once you are an established client, we have a separate check-in process so you do not have to repeat the same intake form over and over. [If you prefer paper intake, please download and print the form].

Insurance Information

MVC or Worker's Comp

If you were in an accident, please provide the following information:

Please be prepared to bring Medical referral or prescription for message to first appointment. This should include a Diagnosis Code.

Primary Insurance Information

If you seek to use your health insurance, please provide the following information:

Insurance Phone

Please be prepared to bring your insurance card/ID to first appointment. We may call before your appointment to verify information. Some insurance providers require a prescription or referral for massage.