Massage Paperwork

Health Questions That Must Be Answered Prior To Your Massage:

All Massage Clients: This is the initial health questionnaire form that everyone receiving treatment will need to have filled out. Click here:

It will greatly speed up the process of your first appointment if you have these forms filled out and bring them to your appointment.

This is our HIPAA compliance form including our privacy policy you will need to read and sign: Notice of Privacy Practices

Note that this is a healthcare treatment and medical record, therefore all information must be filled out on the intake form for a massage treatment to be performed. Email is optional and solely to keep you informed of ongoing exclusive specials.

24 Hours Notice of Cancellation is required if you can’t make it to your scheduled appointment. If  given less than 24 hour notice you may be charged a $35. no-show fee. If your have a discount voucher, Groupon, gift certificate, or other form of prepayment, the funds will be applied to the missed appointment and make your prepayment void for a future use. 

Thanks for bringing these with you to your first appointment.

Below is a list of Medical Conditions that are potentially contraindicated for Massage:

Please review them to see if you currently have any of the conditions. Depending on the condition you may not be able to receive a massage without a medical release from your doctor.
(We reserve the right to refuse serve to anyone)

Gouty Arthritis

Acute Rheumatoid Arthritis

Septic Arthritis

Acute Lupus

Acute Bronchitis



Coronary Artery Disease

Cystitis (Bladder infection)

Infectious Disease

Hemolytic Anemia


Infectious skin disease (including Athlete’s foot fungus)






History of blood clots

Use of Coumadin or blood thinners

Use of Pain killers other than aspirin

Some Recent surgeries

High blood pressure (155/95 or above)

Low Blood Pressure (90/55) or lower

High Risk Pregnancy

For Motor Vehicle Accident (PIP) Claims, print and fill out the forms below:

PIP Initial Registration (Health Intake Form)

2018 Alpine Initial Health Status

Notice of Privacy Practices

neck injury assessment

low back injury assessment

male status report

female status report

MVC Patient Financial Agreement

MVCollision Patient Info