Motor Vehicle Accidents

Complete Form

Please complete the form below. All information is required before first visit. Once submitted, Massage By Kat, will make contact with your adjuster. Some additional information may be required before scheduling your appointment.
Scheduling Call

After contact with adjuster is made, you will be contacted by Massage By Kat to schedule your first appointment and intake interview.
*Please do not schedule on Vagaro for Motor Vehicle Accidents.
First Appoimtment

Usually lasts 90 minutes to 2 hours. We review your accident related pain, document symptoms, give 60 minute massage treatment, then, set and schedule future treatment plan.
All future appointments last around 75 minutes between intake and 60 minute massage.

Motor Vehicle Accident

This information is required before your first visit. Please fill out and review billing information before submitting. You will sign a paper version of this at your first appointment.

Contact Information

Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Preferred Contact Method

Motor Vehicle Insurance

Insurance Company

Claim Number

Date of Accident

YYYY

Adjusters Name

Adjusters Phone Number

Adjusters Fax Number

Billing

I understand that MVA massage services are billed at a rate of $50.00 per unit/15 minutes of massage. I understand that if my Motor Vehicle Accident insurance denies payment for any reason that I will be responsible for the remaining unpaid balance.

Motor Vehicle Accidents

Complete Form

Scheduling Call

First Appoimtment

Motor Vehicle Accident