Attention: Due to complications resulting from the pandemic, we only offer home-based therapy at this time. Many of the forms on our website are not currently in use. This is an archived webpage.
Please fill out your intake forms ahead of time. Call us to determine which forms to bring with you.
Print out your forms, fill them in, and bring them- along with your prescription or referral for massage to your appointment.
In addition to bringing your forms to your appointment, you can also scan and e-mail, fax, or take a legible photo of each page to send to me at:
- email to olueamassage@yahoo.com
- photo and text message to 808-285-3009
- fax to 678-696-6671
- postal mail to Sonia Beauchamp 66-216 Farrington Hwy. Suite 203 Waialua, HI 96791
* Do not email or text message any form that has your credit card number on it.
Kaiser Permanente and HMSA: Forms (2) for ASH Group health insurance massage reimbursement clients
UHA members: All 4 forms need to be received in order for me to submit your treatment plan for approval. This process may take up to 15 days
- Financial Contract This form is necessary in order for me to communicate and bill your insurance provider. I do not need a credit card on file if you agree to my cancelation policy.
- Intake Form
- Assessment Form
- Please also select one or more of the following forms if any are applicable to your diagnosis or injury. Neck Pain, Lower Back Pain, Shoulder Arm Hand or Upper Extremity Pain, Leg Foot or Lower Extremity Pain
Forms for No-fault Auto or Workers' Compensation
- Fill out the on-line information form for pre-authorization by scrolling down to the bottom of this page on my site. After I speak with you on the phone, fill out the following intake form and financial contract. Make sure not to email any forms that have your credit card number printed on them.
- Intake Form
- Financial Contract and Release
- Please also select one or more of the following forms if any are applicable to your diagnosis or injury. Neck Pain, Lower Back Pain, Shoulder Arm Hand or Upper Extremity Pain, Leg Foot or Lower Extremity Pain
HMAA members: one form
Custom Massage Form for out of pocket clients
- 🌴🌴🌴 Short Intake Form 🌴🌴🌴 (If you are paying out of pocket for a custom massage and have an uncomplicated medical history, you can fill out this abbreviated health form. )
Additional Assessment Forms
- Neck Pain
- Lower Back Pain
- Shoulder, Arm, Hand, and other upper extremity pain
- Leg, Foot, and other lower extremity pain