Get 10 - 2011 Massage Only Intake

This guide provides essential information for effectively completing the 10 - 2011 MASSAGE ONLY INTAKE form online. By following these steps, users can ensure they provide the necessary details for their massage care visit, enabling healthcare providers to deliver optimal support.

Follow the steps to accurately complete your intake form.

1. Press the ‘Get Form’ button to access the form and open it in your online editor.
2. Fill in your personal details under the 'About You' section. Include your birth date, social security number, marital status, and contact information including your home address, telephone number, cell number, and email.
3. Identify your parent or spouse if applicable, and provide the name and phone number of an emergency contact.
4. Indicate if you were referred to the office and provide the name of the referring individual, if applicable.
5. In the 'Account Information' section, review and authorize the release of your records to your insurance company and agree to the payment terms. Ensure you include your signature and date.
6. In the 'Consent to Participate' section, read the information regarding potential treatment side effects. Sign and date the form to confirm your understanding.
7. Complete the 'Pre-Massage Questionnaire' by indicating any symptoms, their onset date, how they started, past significant surgeries or injuries, medication details, and any other pertinent medical conditions.
8. Once all information is filled in, review the form for accuracy. Save your changes and proceed to download, print, or share your completed form as needed.

Take charge of your health by completing the intake form online.