Forms
To expedite your check-in process, feel free to print, fill out and bring the required paperwork with you to your scheduled appointment.
For all services:
Medical History Form/New Client Form
Fitzpatrick Scale (Laser or Tixel Consult Appointments)
For massage services (including PIP or L&I claims)
L & I Claims
If you are injured on the job, we can bill Washington State Department of Labor & Industries (L & I) for your medical massage therapy. In order to be eligible for benefits you must report a work injury to your employer and follow the guidelines set forth by the Department of Labor and Industries.
Please bring the following information to your first appointment:
Our L&I form
Date of injury
Claim #
Nature of injury
Claim Manager name & phone number
Whether or not you have been receiving any other benefits
Work status.
Prescription/referral from your physician
Upon your request, Derma Medical Spa provides courtesy billing to the state as well as your insurance provider for your services. If for any reason, benefits are denied or delayed for services that have been provided, you will be billed for the balance on the account. We thank you for your cooperation and understanding.
PIP Auto Injury Claims
We are preferred providers for auto insurance personal injury protection (PIP) plans.
Please bring the following information to your first appointment:
Our Personal Injury form
Insurance card
Claim #
Photo ID
Claim Manager name & phone number
Whether or not you have been receiving any other benefits
Prescription/referral from your physician