SANDRA VIAES RMT
  • Home
  • COVID-19
  • About
  • WHATS NEW!
  • Services
  • Gift Certificates
  • Gallery
  • FORMS
  • Contact

FORMS

Please click on the form you wish to print.
To save time at your initial visit please print and fill out a case history and direct billing consent form (if applicable) and bring in your completed form for your initial visit.

*A complete list of direct billing insurers is available on the "Contact" and "Services" page.
  • Case History Intake Form​
  • Direct Billing Consent Form

Please be aware that depending on how your insurance coverage is set up, payment may only be made to the insurer (you) and be declined to the provider (me). In this case you will have to pay at the time of the appointment and recover the costs from your in
​insurance company.
​

​
  • COVID-19 Pre Screening Questionnaire
    The COVID-19 pre-screening questionnaire will be sent to you the day before your appointment. If you provide a positive screening your treatment will be cancelled and rescheduled for a future date. Any "Yes" answers documents a positive screening. Please be truthful on your questionnaire. Any cold or flu like symptoms can be just that...but do not take any chances. You are risking other client's health as well as mine and my families health since this is a home based business.




Proudly powered by Weebly
  • Home
  • COVID-19
  • About
  • WHATS NEW!
  • Services
  • Gift Certificates
  • Gallery
  • FORMS
  • Contact