In Washington State, licensed massage therapists are healthcare professionals. For safety and security purposes, this online intake must be completed before treatment can be provided. The fields with a red dot require an answer, or the system will not submit it. Thank you!

Your legal first name, date of birth, information about your health, and an accurate mailing address are required by my license. It’s the same as a hospital’s requirements.

I don't bill any insurance or offer 60-minute sessions, but if you plan to seek insurance reimbursement through superbill receipts or intend to request my notes for a PIP claim, later down the road, please send a prescription to my HIPAA-compliant email: toni@vitanovamassage.com or mail it to:

Vita Nova Massage PLLC
223 N Yakima Ave
Tacoma, WA 98403

Ideally, this should be done before your session. The prescription should include:

• Number of treatments allowed

• Diagnostic codes for the areas being treated

• Duration of each session

• The ICD-10 code for Therapeutic Massage

I cannot include diagnostic codes on reimbursement receipts without a valid prescription, as providing a diagnosis is outside my scope of practice. Please verify your coverage first. It’s recommended to renew prescriptions annually, as insurance requirements and policies can change.

Insurance companies may also request chart notes to assess progress. If this may apply to you, please be descriptive about your focus areas and include frequency of symptoms, what aggravates them, how they affect your function or quality of life, and your pain level on a scale of 1 to 10 (with 10 being the most severe). This information helps me create a thorough treatment plan while providing more detailed and supportive documentation. 

Does your healthcare provider have permission to contact you regarding your health information and appointments via (required to select at least one):

The following questions are optional and meant to help me better tailor your session to your needs and goals:

Cupping Therapy: I typically use silicone cups for short durations of stationary cupping and dynamic glides on focus areas. While I aim to avoid leaving marks, some may still occur. I also have the hard-plastic pump cups that are more intense and will most likely leave dark bruises. Most of my clients prefer the silicone cups. This technique works like a reverse myofascial deep tissue treatment, using suction to lift and decompress the tissues. I tailor the pressure and placement to your comfort. Cupping isn’t for everyone, and it’s always optional. It will require more oil-usage. Like everything I use, it’s just one tool to help support your session goals.