Helpful Forms

The following forms are designed to help us work together more easily. Check with me to see what forms you'll need to bring to your appointment!

If you are interested in viewing the official version of HIPAA, all federal regulations are published in the Code of Federal Regulations (CFR), and HIPAA regulations are dispersed within Public Welfare in 45 C.F.R. Part 160, Part 162, and Part 164.

Client Intake Form

If you are a first-time client, please print this 1 page form, complete it, and bring it along to our first session with your signed HIPAA page. This form is for non-insurance clients.

Insurance Intake Form

Please print and fill out this form and bring it with you, along with the signed HIPAA page and your insurance card to your first appointment if you have health insurance or have had an auto accident. For health insurance: Make sure your health insurance company offers massage coverage and check your co-pay and deductables before you come in! You may also fill out and bring in the Intended Outcomes form if you wish.

HIPAA Privacy Policy

Please read, print and fill out the last page of this form and bring with you to your appointment.

Intended Outcomes Form

This form will help you clarify your goals for your overall health and vitality, including our time together.

HIPAA Information

Your medical records are confidential! HIPAA regulatory standards in one document. 115 pages. Current as of March 2013. This is an unofficial version that presents all the HIPAA regulatory standards in one document.

Customer Reference

If you'd like to share your story/comments/review with others on the website, print and fill out this form and mail it, drop it off, or send an email to me via the Contact Me page.

Note: To download Adobe Acrobat Reader for free, click here.