PDF Forms

Prescription Form: This form is for physicians who want to use our simple format. It is also for soft tissue injury patients who want to request a medical massage prescription from their physician.

If you are a physician and you would like to refer patients to us regularly, we will be happy to print your name and relevant information on our form, and have a stack of them bound into a prescription pad and sent to you. If you would like us to do this, please email us a request. Please include your name, the credentials you would like printed on the form, your clinic name, your phone number and fax number, and your license or UPIN number. Please let us know if you would like a pad of 25, 50, or 100 forms. We are also happy to create a PDF for you with the same information on it, and email it to you so that you can simply print one out whenever you need it.

New MVA Form: This form is for motor vehicle accident patients who already have a prescription. Please print it, complete it, and bring it to your first appointment. It will save you some time when you get to our clinic.

Patient Update Form: Regular patients complete this form before each treatment.

New Client Form: Please print, fill out, and bring this form with you to your first visit.