Los Angeles SPA: 310.500.7079

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    Billing Authorization

    I, understand that all insurance billing is done by Massage in LA at 337 S. Beverly Dr. Suite 102 Beverly Hills, CA 90212. All scheduled insurance appointments will be processed unless cancelled 24 hours prior to scheduled appointment time. 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.

      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://
      Sex:
      Address:
      City:
      State:
      Zip Code:
      Phone Number:
      Email address:
      Name of school attending:
      Insurance: UNITEDCIGNA
      Insurance ID Number:
      Areas of complaint:
      Signature:
      [signature* signature cols:300]

        Customer Satisfaction Survey

        On a scale of 1-5, please rate your experience based on the following criteria
        (1= Needs Improvement, 5= Exceptional)

        Date:
        Massage Therapist:
        Client Name:
        Scheduling the Appointment: 12345
        Attention to Problem Area: 12345
        Desired Pressure: 12345
        Professional & Kind Attitude: 12345
        How was the temperature of the room? 12345
        Would you recommend your therapist to others? 12345
        What can we do to improve your experience?
        Did your therapist tell you about our yelp page?

        Get free body scrub

        Make sure to CHECK-IN on yelp to recive a BODY SCRUB on your next appointment!

        LET EVERYBODY KNOW HOW YOU ENJOYED YOUR MASSAGE.

          Existing Client

          First Name:
          Last Name:
          Phone:
          E-mail:
          DOB://
          UNITED or CIGNA:
          ID Number:
          Signature:
          [signature* Signature cols:300]

            Massage in LA - New Client
            Billing Authorization

            I, understand that all insurance billing is done by Massage in LA at 337 S. Beverly Dr. Suite 102 Beverly Hills, CA 90212. All scheduled insurance appointments will be processed unless cancelled 24 hours prior to scheduled appointment time. 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.

            Although we work hard to make sure the billing is accurate, we cannot always guarantee that it will be error-free.
            If you have ANY questions regarding your billing for any reason, please contact us HERE at Massage in LA so we can research and correct it with your insurance carrier.

            Thank you!

            Confidential Client Information

            First Name:
            Last Name:
            DOB://
            Anniversary://
            Phone Number:
            Cell Phone Carrier:
            Email:
            Occupation:
            How did you hear about us?
            Preferred Pressure:
            Preferred Type of Massage:
            Reason for visit:
            Allergic/sensitive to oils or creams?
            Are you pregnant?
            Are you under 18 years old?
            Please list any medical conditions (ie. Cancer, TMJ syndrome, skin disorders etc.) that could affect your massage:
            Please list past accidents and surgeries:
            Are you comfortable with having therapeutic massage on the following areas:
            Gluteal Region: YesNo
            Pectoral Muscles: YesNo
            Scalp: YesNo
            Face: YesNo
            Abdomen: YesNo
            Feet: YesNo
            Here at Massage in LA, we follow a strict set of guidelines intended to provide a safe professional environment for our guests, members and workers. Please let management know immediately if you have any concerns about your session or massage therapist. Male/female genitalia and women’s breasts will not be exposed at any moment in the massage. If you feel uncomfortable at any moment during the session, request your therapist to end the session immediately. It is your responsibility to inform us of any existing conditions, disabilities or sensitivities and to inform your therapist if you feel any discomfort during the massage. Because therapeutic massage/bodywork should not be performed under certain circumstances, you affirm that you have stated all medical conditions of which you are aware and will inform your practitioner of any changes in my medical status. You understand that therapeutic massage/bodywork should not be construed as a substitute for medical examination, diagnosis or treatment. We may, in our sole discretion, refuse or discontinue massage services if we determine such services may be unsafe or cause discomfort to you. The undersigned acknowledges he/she has read and undersigns this disclaimer.