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Client Forms

New Clients:

As a new client (or newly filing an insurance claim), you will need to complete several of these forms. Health history is required for all clients; the others are only needed if you plan to pay for treatment through medical or auto insurance. For general information about insurance coverage, click here.

  • Insurance Coverage - a set of questions you can ask your carrier to clarify your coverage for alternative therapies (optional)  Download Insurance Questionnaire
  • Health History Form - for women  Download Client Intake - Woman
  • Health History Form - for men  Download Client intake - Man
  • Health History Form - for girls (under 18 years old)  Download Client intake - Girl
  • Health History Form - for boys (under 18 years old)  Download Client Intake - Boy
  • Insurance Information - Medical Claim, adult  Download Medical Claim - Adult
  • Insurance Information - Medical Claim, child  Download Medical Claim - Child
  • Insurance Information - PIP/Auto accident Claim, adult  Download Auto Accident Claim - Adult
  • Insurance Information - PIP/Auto accident Claim, child  Download Auto Accident Claim - Child
  • Prescription for Massage Services - generic form  Download Prescription Form


For Richard's clients:

These are essays that Richard has written about posture and maintaining core balance. They are great reminders as you work together on improving your health and alignment.

  • Download Alignment, balance and core muscle tone
  • Download Finding your balance
  • Download Strategies of stability

For Lauren's clients:

These are articles and handouts that Lauren has written to help clients (and students) learn about the work she does, or how to take care of themselves at home.

  • Self-care for TMJ and Jaw Problems  Download TMJ Homecare
  • Intraoral Work and Jaw Pain  Download Intraoral Essay

Blogs

  • Richard's Blog
  • Richard's Blog Image
  • Lauren's Blog
  • Lauren's Blog Image Lauren's Blog Image 2 Little Frog
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  • Get Directions to Our Clinic