Forms for Massage
Step 2: Decide how you will be paying for your massage.
Optional: Click Here for Page Contents a list of all the available forms furnished by our office.
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Leilani took this picture at the Mt. Vernon Orchid Show Feb. 2007.
Everyone start with:
Decide how you will be paying for your massage.
Options for payment are
"Same Day Pay" = you are planning to pay check, cash or use debit/credit card/HSA t the time of your massage. You can even prepay when you book your appointment here
OR "Billed / Insurance"
= you are planning to have our office bill your insurance company for your
payment for your massage. For information on
Same Day Pay Column 2
Billed/Insurance Column 3
3rd: If you want you can fill out your forms and bring them to your massage session, saving you time!
Please do not forget to bring your forms with you or you will just have to fill them out again when you arrive. (or you skip this step and you can fill out the medical history form online if you book your own appointment here )
Thank you for your patience and thoroughness with your forms. This process helps us save you time and process your bills.
Same Day Pay
If you are planning to pay by check,
cash, or use your debit or credit card to pay for your massage
B. Please read this, print and sign our Payment Policies and arrangements here.
D. Bring completed forms to your
appointment or scan and then email them to leilani @ leilanimassage.com.
You're ready for your massage appointment !
is a copyright photo of one of Leilani's
Billed / Insurance
If you are having our office bill your insurance company or attorney or third party for your massage, please print and fill out only the forms in this column that apply to you & your insurance company.
Please read all the way through to see if each item applies or not A through H.
We recommend you verify your specific massage benefits which you can do by calling them (phone number is usually on your insurance card back) and asking the information on this form click here for the insurance verification form.
This way we can make sure you have massage benefits and whether or not you need a referral from your doctor prior to your appointment. You may also have to pay a deductible, copay or coinsurance at the time of your massage. These details of the insurance plan are decided by your insurance plan and your plan selection. If you want more details, please feel free to call us or your insurance plan directly.
D. Please read this, print and sign our Payment Policies and arrangements here.
E. Referral or prescription
Almost all insurance plans require a referral or prescription (several even require prior authorizations) for massage therapy treatment.
Prior to your appointment, please either call to your doctor's office or your insurance to confirm the insurance company has received the referral/prescription from your doctor or you can plan to bring it with you to your massage appointment.
F. Please remember to bring your completed forms to your appointment or scan and email them to leilani @ leilanimassage.com or you can picture message them to my cell phone at 206-914-3885
Now you're ready for your massage appointment !