Forms

Forms for clients to download are here.

1) Cash Payment:
This category is for clients who wish to come into the office and will be paying by cash, check or Major Credit cards. Some insurance companies do not, at this point in time, accept certain modalities as billable services. Some techniques, such as Reflexology, Chi Nei Tsang, Arvigo Method, Reiki, etc. are whole systems and are not regarded as site specific. This does not say that, given research developments, these modalities might be recognized at some undetermined time. We will edit our website if there are any changes.

However, we will be happy to provide a receipt for you to apply towards your Health Savings Plan or any other wellness program that you have in place. Please refer to the forms section to complete the Intake Form and Consent for Treatment and bring the forms with on your first visit. Thank you.

Client Information Form
Consent Form

2) Insurance Billing:
Currently we accept Motor Vehicle/PIP claims, Labor and Industry/Workman’s Compensation, and the following Major Medical Insurances:
Aetna, United, First Choice, Cigna and various other affiliated companies.
We are NOT a preferred provider for: Regence, Premera or Group Health.

Please note that no medical massage can be rendered without a prescription from your primary. Noted as well that a prescription is different than a referral, which only directs that the client can pursue a CAM (Complimentary Alternative Medicine) provider but it does NOT specify what kind of work will be provided, where, frequency and for how long. The prescription, along with a referral (which might be optional depending upon your plan); please refer to the Notice to Patient Regarding Other Coverage form for further clarification.

Please complete the attached forms in this section in order that we might render the best and most appropriate treatment for you and your condition. In addition, please be prepared to pay any co-pays at time of service. For your convenience, we are happy to take a photocopy of a major credit card to keep on file to cover for any co-pays or co-insurances.

Medical Release Form
Authorization of Insurance Payment
PIP Information Form
Insurance Information
Intake Form
Notice to Cx