- Self-pay (non-insurance): Payment in full is collected at time of service by cash, check, or credit card.
- Medical insurance: Prescription required! Any payment (co-pay, co-insurance, deductible) is due at time of service. My insurance company will be billed for the balance, if I have coverage for massage treatment and it has not run out. If the insurance company denies my claim, I am responsible for the full remaining balance. Please note that insurance does not cover massage therapy for maintenance or stress.
- Personal Injury/PIP (car accident): Prescription required! I will contact my automobile insurance company to let them know about my care and to request that forms be sent to initiate a claim. I am still responsible for my bill, but I will not be required to pay at the time of service if my insurance company establishes payment. No reduction of payment will be accepted. Please note that a medical lien may be filed in some situations. Third-party claims (e.g., no personal injury coverage) are not accepted at this time.
- Workers Comp/L&I: Prescription required! A claim will be filed, as long as a valid L&I claim number and prescription are obtained prior to treatment. It is understood and agreed that, if L&I denies my claim, even after treatment has been completed and the account has been paid in full by L&I, I agree to reimburse in full for the total "charge back" from L&I within 30 days of notification of "charge back" from this office or from L&I.
The appointment is set aside for me. If I cannot keep my appointment, I understand that this office requires 24 hours notice to avoid being charged for the visit. If I cancel less than 24 hours in advance, or if I do not show up for a scheduled appointment, I will be charged the full reimbursable amount for that appointment, with a minimum charge of $45.00. A cancellation due to emergency (e.g., illness) may or may not result in a charge, at the therapist's discretion.
If I show up late for my appointment, I will only be given the remainder of the scheduled appointment time. I will be required to pay for the full time allotted for my massage. I understand that the therapist will not be able to add time to the end of my scheduled appointment time to make up for time lost for being late. If I show up 15 minutes late or more, my appointment will be cancelled, and I will be responsible for paying the full value of my appointment, which is not billable to my insurance company.
MEDICAL CONCERNS and other:
If I am ill on the day of my scheduled appointment, I will call to reschedule. I will not be massaged if I have a fever, contagious or mysterious skin rash, or other contagious illness, such as the flu.
I understand that massage therapy is provided for stress reduction, relaxation, relief from muscular tension, and improvement of function.
If I experience pain or discomfort during the session, I will immediately inform my therapist so that pressure/strokes can be adjusted to my level of comfort. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session.
I understand that the services offered today are not a substitute for medical care. I understand that my therapist is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness.
I affirm that I have notified my therapist of all known medical conditions and injuries.
I agree to inform the therapist of any changes in my health and medical condition. I understand that there shall be no liability on the therapist’s part should I forget to do so.
I understand that massage is entirely therapeutic and ethical in nature. Misconduct will not be tolerated. I understand that any illicit remarks, advances, or gestures will result in immediate termination of the session, and I will be liable for the full payment of the scheduled appointment. Authorities may also be contacted.
Please note that this is a summary of office policies.