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.

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 (including but not limited to new/update no-fault claim, new/update private health insurance).

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

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, 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

New York Motor Vehicle No-Fault Insurance Law Assignment of Benefits Form

Please complete this form if you are a new no-fault client or if you are a current client with a new no-fault claim.

http://massagebyjp.massagetherapy.com/images/NYS-NFAOB(JP)_2014-3-04i.pdf

Physician/Health Care Provider Referral

Please have your physician/health care provider complete this form if you are a new no-fault client, a current no-fault client with a new claim, and/or your private health insurance requires a referral for Massage Therapy prior to treatment.

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

Associated Bodywork & Massage Professionals
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