Currently we do not have any openings for any new clients with a prescription for massage therapy.
Medical Massage Forms
Required Paperwork
If you cannot download or print these forms, but would like to complete them prior to your appointment, please contact us and we will mail them to you, or we can arrange a time for you to pick them up at our office.
ERTM Medical Massage Referral_Prescription.pdf (Preferred Prescription/Referral Form)
Please download, print and ask your health care provider to use our form for prescribing or referring massage. If they do not use our form, please ensure that your prescription / referral includes diagnosis code(s), requested treatment type (97124 Massage Therapy or 97140 Manual Therapy Techniques), a treatment goal, duration and frequency of treatment, and reporting instructions.
ERTM Medical Intake.pdf(Confidential Intake, and Policy and Rates agreement)
Please download, print and bring the completed form with you to your appointment. You may complete this form at our office, but most clients prefer to do this at home as it may require information you may not have with you at the time of your appointment.
ERTM Insurance Registration Form.pdf(Detailed Insurance Company Information)
Please download, print and bring the completed form with you to your appointment. You may complete this form at our office, but most clients prefer to do this at home as it may require information you may not have with you at the time of your appointment. Remember to bring your insurance card to the appointment.
ERTM Insurance Benefits Verification Form.pdf (Detailed Insurance Coverage Information)
Download and print this form if you would like to contact your insurance company yourself to verify if massage therapy is a covered benefit and the total $ amount of your benefits, yearly deductible and any co-pay you may be responsible for.
Our medical billing service representative will contact you directly if there are any questions or concerns about your insurance.
We offer a no interest payment plan for patients without insurance or are denied insurance coverage for massage therapy. Please contact us for more information.
If you cannot download or print these forms, but would like to complete them prior to your appointment, please contact us and we will mail them to you, or we can arrange a time for you to pick them up at our office.
ERTM Medical Massage Referral_Prescription.pdf (Preferred Prescription/Referral Form)
Please download, print and ask your health care provider to use our form for prescribing or referring massage. If they do not use our form, please ensure that your prescription / referral includes diagnosis code(s), requested treatment type (97124 Massage Therapy or 97140 Manual Therapy Techniques), a treatment goal, duration and frequency of treatment, and reporting instructions.
ERTM Medical Intake.pdf(Confidential Intake, and Policy and Rates agreement)
Please download, print and bring the completed form with you to your appointment. You may complete this form at our office, but most clients prefer to do this at home as it may require information you may not have with you at the time of your appointment.
ERTM Insurance Registration Form.pdf(Detailed Insurance Company Information)
Please download, print and bring the completed form with you to your appointment. You may complete this form at our office, but most clients prefer to do this at home as it may require information you may not have with you at the time of your appointment. Remember to bring your insurance card to the appointment.
ERTM Insurance Benefits Verification Form.pdf (Detailed Insurance Coverage Information)
Download and print this form if you would like to contact your insurance company yourself to verify if massage therapy is a covered benefit and the total $ amount of your benefits, yearly deductible and any co-pay you may be responsible for.
Our medical billing service representative will contact you directly if there are any questions or concerns about your insurance.
We offer a no interest payment plan for patients without insurance or are denied insurance coverage for massage therapy. Please contact us for more information.