Get the free Massage Referral Form - Balanced Health Massage and Spa

Alpine Therapeutic Massage Referral Form Patient Name: is referred to Phoenix Alexander for massage therapy treatments. Diagnosis for massage therapy: X 728.85 Muscle spasm E812.0 Coll. W/mot. HCL.

How to fill out massage referral form

How to fill out massage referral form

1. Step 1: Start by gathering all the necessary information such as the patient's name, contact details, and any medical history relevant to the massage therapy.
2. Step 2: Fill in the date when the referral was received or issued.
3. Step 3: Provide the referring healthcare professional's name, contact information, and any necessary identification numbers.
4. Step 4: Describe the reason for the referral, including any specific areas or conditions that require attention during the massage therapy.
5. Step 5: Specify any restrictions, precautions, or contraindications that the massage therapist should be aware of.
6. Step 6: Include any additional notes or instructions that may be relevant for the massage therapist's reference.
7. Step 7: Review and double-check all the filled-out information for accuracy and completeness before submitting the referral form.

Who needs massage referral form?

1. Patients who have been recommended or prescribed massage therapy by their healthcare professionals.
2. Insurance companies or third-party payers who require a massage referral form as part of their reimbursement process.
3. Massage therapists who need a record of the referral to ensure they are providing appropriate and targeted treatment.
4. Healthcare professionals who want to communicate specific information or instructions to the massage therapist for a particular patient.

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What is massage referral form?

Massage referral form is a document used to refer a client to a massage therapist.

Who is required to file massage referral form?

Healthcare providers, such as doctors or physical therapists, are required to file massage referral forms.

How to fill out massage referral form?

To fill out a massage referral form, the healthcare provider must enter the patient's information and the reason for the referral.

What is the purpose of massage referral form?

The purpose of a massage referral form is to connect patients with qualified massage therapists for treatment.

What information must be reported on massage referral form?

The referral form must include the patient's name, contact information, medical history, and the recommendation for massage therapy.