Patient Forms

Initial Patient Forms Packet

For your convenience the following forms are to be downloaded, printed and completed in advance of your initial treatment session with Michigan Auto Injury Massage Therapy, LLC. (MIAIM) You may choose to fax or email the completed forms to MIAIM prior to your first appointment or have them available at your first session.

Detailed instructions are supplied to help with each forms completion.

Thank you for choosing MIAIM to be your massage therapy provider.

1a ASSIGNMENT OF BENEFITS/RELEASE OF RECORDS/PAYMENT AGREEMENT Form (1 page)
1b Instructions and sample (1 page)

2a CMS Billing Form/Signature on File (1 page)
2b Instructions and sample (1 page)

3a Patient Information Form (2 pages)
3b Instructions and sample (2 pages)

HOW TO DOWNLOAD AND USE FORMS

Click the Download button and when prompted choose Save and save to your desktop. When download is complete go to your desktop and double click the shortcut MIAM Forms. (Single click for Mac users) Once open print all pages, or to save a tree and ink, print the four “Client Intake Forms” only and view the “Sample Forms with Instructions” on your display. Complete forms and have available at your first massage session.

Download Sample Forms with Instructions

Download Client Intake Forms

Should you have problems or questions regarding the download procedure or completing forms contact us at 248-854-6068.