Medical Forms

Intake Forms

First-time self-paying massage and colon hydrotherapy clients - Print and fill the appropriate form and bring it to your initial appointment:

Massage Client Intake Form

Colon Hydrotherapy Client Intake Form

Insurance Forms

When you've been injured in a car accident or at work, this prescription makes it easy for your doctor to prescribe massage therapy for you. Simply print out this form and have your doctor - MD/DC/ND/DO - fill it out and bring it with you to your first appointment.

Prescription Form

First time motor vehicle accident patients - please print out this form, fill it out and bring it with you to your first appointment.

MVA Intake Form

First time Worker's Comp patients - please print out this form, fill it out and bring it with you to your first appointment.

Worker's Compensation Intake Form

Returning motor vehicle accident and Worker's Comp patients - please print out this form, fill it in and bring it to your subsequent appointments.

Update Form

Please note that Éireen does not bill managed care providers (HMOs or PPOs) or Medicare.