Medical Community &
Health Care Providers

Thanks You For Your Trust In Us!

We Accept Referrals For:
• Active Myofascial Therapy™
• Post P.T. Rehabilitation Therapy
• Weight-Loss Programs
• Fitness Programs
• Pre & Post Natal Fitness Programs
• Ergonomic Consultations & Education
• Ergonomics for New Moms & Dads
• Relaxation Massage
• Orthopedic & Medical Massage

Rest assured when you refer your patients to us
they will be treated with the utmost in care!

You Can Trust Us!
• We are 100% HIPAA compliant, (Health Insurance Portability and Accountability Act)
• We keep detailed progress notes on each and every appointment in the SOAP format.
• You will receive a copy of your patient’s initial evaluation and subsequent re-evaluation reports.
• You may request copies of any patient’s records with their signed release.
• Our director will personally over-see all therapy you prescribe for your patients and will be your contact person here if you need any specific information or have any specific direction for the therapist to follow.

Insurance Accepted:
• Workers’ Compensation
• Motor Vehicle Insurance
• Discount offered on some services since we are Preferred Providers for:
     Blue Cross
     American Specialty Health
     United Naturally (United Health Care Services, Inc.)

Insurance Reimbursement:
Once we have your Rx, we handle it all:
• Insurance verification
• Authorization
• Claim submission

Self-Pay Patients:
• Discount to self-pay patients on some services
• Detailed Superbill provided to patient for own submission
• No Rx required

Support For You:
• Personalized, printed Rx sheet for your future referrals (See form below)
• Poster for your office regarding the benefits of massage
• Copies of patients files at any time
• Direct communication with Diamond Massage & Wellness Center’s director regarding your patient’s care.

Please complete this form and let us know your interests in how we
can help you help your patients.
We will contact you in the next few days.

Specialty *

First Name*

Last Name*

Degree/Title*

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City

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Phone*

Primary E-Mail*

Please Explain How We Can Help You!

Please contact us by phone 415-921-1290 or email if you have any questions on how we may best help you and your patients.