Appointments / Contact

Submitted by Anonymous on Sat, 11/12/2011 - 01:35

To schedule an appointment, please look at our availability and then fill out the below form. Alternatively, you may call 206-226-8953. If we are unavailable or with another client, please leave a message.

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Name *

Phone *

Address

Dates and times you are interested in receiving a massage

Are you planning to use your insurance for the massage?

Yes

Have you given us your insurance information previously?

Yes

Insurance Information

Your date of birth

Name of primary insurance holder (your name if you)

Date of birth of primary insurance holder (your name if you)

Type of insurance

Claim/Case/Subscriber number

(If applicable) Group number

Do you have a prescription or referral for Massage Therapy?

Yes

Appointments / Contact

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