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AUTO ACCIDENT INJURY TREATMENT
An 'Open' Auto Accident Insurance claim must be verified before treatment is rendered.
Please fill out the 'Verification' form below and I will respond ASAP. Thank you.
According to the Auto Accident Insurance Policies,  you will  need a massage prescription before treatment is rendered. You can receive one from your Medical Doctor or Chiropractor.
*The prescription must have diagnosis codes,  frequency and duration of massage therapy treatment allowed.
 
During most auto accidents, the high impact of the crash forces the muscles in the neck and entire body to respond and 'brace for impact' very quickly. The head lunged forward and quickly whips back causing tissue damage that is knows as 'whip lash' that can effect the neck and the entire body.
Massage Therapy is very helpful in the healing and recovery process of whip lash. Therapeutic massage releases muscle tension while increasing range of motion which is crucial in auto accident injury recovery.

 
 

Auto Accident Insurance Claim Verification Form .
Please fill out as much information as you can. All information is kept confidential and is used only to verify the
Auto Insurance Claim.
Please give a 24 Hr. notice if you need to cancel an appt.
Regretfully, you will be charged the full amount if notice is not given.
 
First Name
Last Name
Contact Phone Number
Date of Birth
E-Mail Address
Street Addess (include zip code)
Name of Auto Insurance you opened your claim with
Claim Number
Date of Auto Accident
Name of Insurance Adjuster (First & Last Name)
Adjuster's contact phone number
Insurance billing address
Where you the driver of the vehicle or a passenger?
Driver
Passenger
Did you receive Hospital Care for your Injuries?
Yes, right after the accident.
Yes, but not right after the accident.
No.
Please briefly explain the auto accident
Are you currently receiving therapy for your current auto accident injuries? if yes, what therapies?
How long have you been receiving the above therapies? (If applicable)
Has your Insurance Company request that you see an IME? (Independent Medical Examiner)
Yes
No
Have you obtained a Massage Therapy Prescription from your Doctor?
Yes.
Not yet.
What pain symptoms are you currently experiencing?