Please print and complete your Health Intake and Consent Form BEFORE coming to your appointment. This saves time and lets you fully enjoy your massage session.
At the bottom of this page you can download a template document to fill in online, or a PDF document to print out.
First-time clients, you are responsible for verifying your benefits and costs prior to you appointment, and to provide a referral if required by your plan. Failure to do so may result in you paying for your visit and seeking reimbursement from your insurer.
You are financially responsible for your deductible, copay, and/or coinsurance as well as any service charges that your insurance does not cover.
Be sure to fully complete the insurance information page of your intake paperwork if you need us to bill your health insurance, L&I or workers compensation, personal injury, or auto accident insurance.
Please also note that you must bring your insurance card, driver's license or other photo identification, and (if needed) your doctor's referral and/or prescription to your appointment.
* Massage Doctor is NOT a provider with Cigna or American Specialty Health.
** Kaiser patients: Your doctor must put a referral in their system even if it is not required -- otherwise Kaiser will not pay for your massage.
OUR POLICY FOR 24 HOURS NOTICE:
* If you do not show for a scheduled appointment without canceling, you will be charged the full fee of the scheduled service.
* If you cancel with less than 24 hours notice, you will be charged half the fee of the scheduled service, unless the scheduled time is taken by another client.
* If you are more than 15 minutes late for a scheduled appointment, you may be required to reschedule and the rescheduling fee may apply.
* Payments for cancellations and no-shows are due upon receipt of the invoice.
* There will be a charge for any checks returned due to Non-Sufficient Funds (NSF) per Washington State law (RCW 62A-3-515).
* We reserve the right to treat each situation on a case-by-case basis.
If you are a under age 18, it is Washington State law that a parent or guardian consent for your massage therapy. Please print and complete the Parental Consent form below.