Billing Authorization I, understand each massage session will start once both client and massage therapist are ready. Arriving late to your scheduled appointment will cut into the time of your session. Confidential Client Information DOB:Month123456789101112/Day12345678910111213141516171819202122232425262728293031/Year2000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Sex: FemaleMale Address: City: State: Zip Code: Phone Number: Email address: Name of school attending: Insurance: UNITEDCIGNA Insurance ID Number: Areas of complaint: NECKMID-BACKLOW-BACKHIPSSHOULDERS Signature: [signature* signature cols:300]
