Massage By JP

Client Forms

The forms on this page can be completed prior to your visit to help maximize our time together.  If you have any questions, please do not hesitate to contact me.  MassageBook also has a basic Massage Therapy Intake with the Office Policies/Waiver that may be completed online prior to your visit.

Patient/Client Registration

The Patient/Client Registration form is a universal form that is utilized by the Acupuncture, Chiropractic and Massage Therapy Practitioners within the Seneca Springs Office, which includes myself.  Please complete this form if you are a new client, new to the Seneca Springs office, have not seen me in a year or more, AND/OR if any changes have been made to your contact information and/or any of your insurance information

http://massagebyjp.massagetherapy.com/images/Registration_2015-01-02.pdf

Health Information

The Health Information form is a universal form that is utilized by the Acupuncture, Chiropractic and Massage Therapy Practitioners within the Seneca Springs Office, which includes myself.  Please complete this form if you are a new client, new to the Seneca Springs office, you have not seen me in a year or more, and/or if a substantial amount of your health information has changed since your last visit.

http://massagebyjp.massagetherapy.com/images/HealthInfo_2014-02-07i.pdf

Office Policies/Waiver

The Office Policies and Waiver form is a universal form that is utilized by the Acupuncture, Chiropractic and Massage Therapy Practitioners within the Seneca Springs Office, which includes myself.  Please complete this form if you are a new client, new to the Seneca Springs office, have not seen me in a year or more, and/or if you communication preference needs to be updated/changed.

http://massagebyjp.massagetherapy.com/images/Policies_2015-01-02.pdf

Physician/Health Care Provider Referral

Please have your Primary Care Provider or Medical Specialist complete this form if your private health insurance requires a referral for Massage Therapy prior to treatment or you have a medical condition that is questionable or may be contraindicated for Massage Therapy (PCP or Specialist recommends Massage Therapy with special instructions, etc).  Your Provider may also write a referral/script for Massage Therapy that must include their information, the diagnostic codes, and any other important information regarding treatment.

http://massagebyjp.massagetherapy.com/images/ProviderReferral(JP)_2014-03-04i.pdf

Associated Bodywork & Massage Professionals
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