Massage Paperwork

Health Questions That Must Be Answered Prior To Your Massage:

It will greatly speed up the process of your first appointment if you have these forms filled out and bring them to your appointment.

All Massage Clients: This is the initial health questionnaire form that everyone receiving treatment will need to have filled out. Click here: massage intake form_2017

This is our HIPAA compliance form including our privacy policy you will need to read and sign: Notice of Privacy Practices

Note that this is a healthcare treatment and medical record, therefore all information must be filled out on the intake form for a massage treatment to be performed. Email is optional and solely to keep you informed of ongoing exclusive specials.

24 Hours Notice of Cancellation is required if you can’t make it to your scheduled appointment. If less than 24 hour notice you may be charged a no-show fee, or if your have a discount voucher, you may be charged the full value amount to redeem it at another time. 

Thanks for bringing these with you to your first appointment.

Below is a list of Medical Conditions that are potentially contraindicated for Massage.

Please review them to see if you currently have any of the conditions. Depending on the condition you may not be able to receive a massage without a medical release from your doctor.

Gouty Arthritis

Acute Rheumatoid Arthritis

Septic Arthritis

Acute Lupus

Acute Bronchitis

Cancer

Cellulitis

Coronary Artery Disease

Cystitis (Bladder infection)

Infectious Disease

Hemolytic Anemia

Hepatitis

Infectious skin disease (including Athlete’s foot fungus)

Influenza

Phlebitis

Embolism

Shingles

Tuberculosis

History of blood clots

Use of Coumadin or blood thinners

Use of Pain killers other than aspirin

Some Recent surgeries

High blood pressure (155/95 or above)

Low Blood Pressure (90/55) or lower

High Risk Pregnancy

 

For Insurance (Medical Massage) Clients Only:

Massage for Injury and PIP  Auto Accidents, you will need to fill these out: Injury intake form  low back neck assess.

If you’re female fill out this female status report

If you’re male fill out this form male status report

Contact Phoenix at: 253-838-3336

AlpineTherapeuticMassage@gmail.com

 

 

 

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