Be Refreshed, Relaxed & Rejuvenated

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Forms in .pdf format





Personal Health Information - This two page (intake) form must be filled out and signed by all new clients before any treatment or service can be provided.  Print this form and bring the completed form to your first visit to expedite the intake process.
Prescription Form - This form must be completed by your chiropractor or medical physician for any motor vehicle insurance claim.


MVA Insurance Form - This form must be completed in order to submit claims to your motor vehicle insurance company.


Consent to Treat a Minor Form - This form must be completed by parent or legal guardian before any treatment or service is provided.  The parent or guardian must accompany the minor in the treatment room unless parent gives permission for the child to be left alone with the therapist and signs off giving their consent.    For our purpose,  a minor is anyone age 16 and younger.


Cupping Therapy Client Release Form - This form allows the Cupping Practitioner to perform Cupping.

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