|
| | | |
Welcome to Massage Therapy.
|
|
|
Fill out the blank spaces below as best you can.
|
| 1. do you have
any of the following coverage?
medicare? yes no
medicaid?
yes no
a group health plan?
yes no
2. your name:
3. your birthday
4. male or female
(circle one please)
5a. your address:
5b: your phone number:
6. is the insurance
under your name?
yes no
7. what type of insurance is it?
car insurance?
yes no
health insurance?
yes no
7b. name of the insurance company:
7c. insurance company address:
7d.
insurance company phone number:
8. Policy #
9. Claim #
10. name
of the person handling the claim and their phone number:
11. Date
the injury occured:
12. if you were hospitalized please record
the date here:
|
| My appointment times
1.
2.
3.
| |
Hi,
Welcome to Massage Therapy.
I'm
sorry to hear that you are not feeling well. Water House Wellness and Dr. Tomkins are going to work together to try to make
you more comfortable.
Let me tell you what you can expect from your treatment.
Today, you will receive a prescription for massage therapy.
Dr. Tomkins will determine a certain amount of treatments over the course of the next few weeks to assist
you in healing from your injury. The prescription will state what the injury is and how often you should be treated.
Next, you should call Water House Wellness at 1.781.643.4400
and make a series of appointments.
State on the phone that you have
a prescription, and be ready with your calendar to schedule at least the first 2
appointments.
Keep notes about how you are feeling.
It's important to track how you feel the day of the injury and after that for insurance reasons and treatment
options. How you are feeling in the days following and injury may determine the course of action you'll want to take
with massage and other alternative health treatments.
Do yourself a big favor
and just write a couple words describing how you feel on the calendar: "pain in my shoulder and neck,
it hurts to look up" is an example.
Are
you skipping work or not doing the activities that you normally do?
Note
these days as well.
The first day of your treatment I will spend time will you to make sure we have all the paperwork
in order. If you fill out everything on this form we should be all set. Don't worry if you don't have all the answers. The
first day your massage hands on time may be shorter than an hour so that your body can adjust to massage therapy, and so that
all the paperwork can be completed.
After the first treatment I will touch base with Dr. Tomkins. I'll confirm
that treatment has begun and that I will be sending progress reports. Each week, we will fill out a progress report together
and Dr. Tomkins will receive a copy.
If you are new to massage therapy it's normal to be nervous. Remember that
you deserve to be pain free, and that it may take some time to heal. If you are overwhelmed, bring all your questions with
you to the massage therapy appointment, and we'll make time for each one.
I look forward to meeting you!
-Kelly
Fitzpatrick, CLMT
1.781.643.4400
| |
Attatch your perscription here. |
|
| About Us |
a
little info about massage.
the first time you get a massage it's normal to be nervous.
remember that you
are in charge and the treatment is for you.
come to the office about 10 minutes early. there is parking on the
street and behind the office.
when you arrive to the office there is a little bit of paperwork to fill out. then
I'll show you the treatment room and where the bathroom is. once in the room we'll talk about what areas of your body you
want to work on, and what kind of massage pressure you feel best about.
at this point I'll leave the room for you
to climb in between the blankets on the massage table. If you are comfortable, you can take off the clothes over the area
that we'll be working.
the massage will focus on your injury and should feel good, like it's helping.
the whole thing fits into an hour.
you can stop or ask questions at any time.
waterhousewellness.com
| |
|
| |
|
|
| Save 10% |
If you are new to massage therapy and your insurance is not covering your treatment, Don't worry, healing can be
affordable. Receive a 10% discount when you come for five or more treatments.
| | this offer never expires. treatments must be paid
for in advance in groups of five | |
|
|
