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4 Units or (1 Hr) of Medical Massage/Manual Therapy. 

This is not a relaxation massage.

This is outcome-based bodywork and massage, prescribed or referred by a medical doctor, dentist, chiropractor or acupuncturist.

 Some cases may be covered by insurance. Before coming in for your Medical Massage, please read our Medical Massage Questionnaire.

MEDICAL MASSAGE Questionnaire

Medical Massage Is outcome-based manual therapy (bodywork) and massage prescribed or referred by a medical doctor, dentist, chiropractor or acupuncturist.

Specific treatment protocols are targeted to a diagnosis provided by the referring physician and administered after a thorough assessment/evaluation by the medical massage therapist.

This is not a relaxation massage.

Some cases may be covered by insurance.  In order to determine if your therapy is covered in part or in full or not at all, please answer the following questions:

Have you been involved in an accident?    Yes ____     No ____

Was a motor vehicle involved in the accident?    Yes ____     No ____

Does your Auto Insurance Policy have PIP (Personal Injury Protection) coverage?

Yes ____     No ____   $ ________

Have you been injured at work?    Yes ____     No ____

Do you have a prescription for Manual Therapy and Massage Therapy from your doctor?

Yes ____     No ____

Does your Health Care Plan cover Manual Therapy 97140?

Yes ____     No ____

Does your Health Care Plan cover Massage Therapy 97124?

Yes ____     No ____

Do you use Medicare exclusively?

Yes ____     No ____    (If yes, Medicare has no coverage.)

Please email your questions or concerns to: michael@inclinemassage.com

 Download a Medical Massage Rx Form


Date/time:Choose one of the openings below. (PST)