New Client Resource Page

Welcome to the Tree of Life Center for Wellbeing

Dana Tavares LMT.

 

This is your resource page for contact information, policies, and intake forms.

All sessions are by appointment only. When you call to set up your appointment your selected time and day will be penciled into our appointment schedule. New clients may download and print the forms below, fill them out ahead of time, then bring them in for your first appointment.

The day before your appointment you will be sent (via text message or, if you prefer, by email) two links regarding COVID19 that will need to be completed online before your appointment can be finally confirmed. You may also access the HIPPA approved forms below. Once completed, a confirmation will be sent to you for your appointment. Please let me know if you do not receive this info the day before your appointment! Often times, due to our schedule, these forms may not be sent until early evening.

***Please do not wear perfumes or scented lotions etc.***

Contact Info

Text / Voice: (207) 563-2737.        Fax: (207) 563-6582
email: treeoflifecenter@roadrunner.com
website / blog: center4wellbeing.com
Directions to our office: https://center4wellbeing.com/contact/directions-to-tlc/

 

New Client Intake Forms

(please print these, sign and return, when you come in for your first visit)

(print and fill these out at your convenience. Then bring them in for your first visit)
New Client Intake Form (2-pages). No need to fill in the insurance section if you are self-pay.
TLC intake form pg. 1
TLC intake form pg. 2

Insurance Forms

(only for insurance coverage)

Workers Comp generally pays LMTs without any problem. A referral from your doctor is necessary. Personal injury often pays claims from LMTs thru your lawyer.

Major Medical is a lot more difficult. We do our best to verify coverage but cannot guarantee it. You will be responsible to cover claims denied. We will require a picture or copy of your insurance card and a referral, in most cases, from your doctor. If you call your insurance company to verify your coverage for massage therapy you need to specifically ask if they cover massage therapy, if you need a referral, and if they pay directly to LMTs or if you have to pay and then file for reimbursement. You should also ask about your deductible and co-insurance requirements.

TLC Privacy Statement   (print for your records)
Blank_reciept_of_privacy_notice   (print, fill out, bring in)
Assignment of Benefits, Records Release, Payment Agreement (print, fill out, bring in)
TLC_HIPAA_Authorization_Form  (print, fill out, bring in)

TLC Membership

Membership Description
Membership Enrollment
TLC Credit Card Requisition Form

TLC Covid Info

We take the Covid19 virus very seriously and strive to maintain a safe environment and experience for everyone. Before your massage can be confirmed it is important that we know if you’ve had Covid19 in the past or experiencing any symptoms currently. We require you to use the links below to answer basic questions prior to your appointment. We use a HIPPA compliant format for this so your information is safe and secure.

You will be asked to reschedule if you are exhibiting any symptoms of illness when you arrive.
We require mask at all times.

The Pre-massage Covid Check In will be sent to you via text or email the day before your appointment and must be completed to confirm your appointment. ( one of the questions is if and when you’ve had the Covid vaccine. Your answer is optional, but is helpful for us and may help determine how we schedule our clients and structure our safety protocols). FYI, Dana Tavares LMT has been fully vaccinated and will be wearing a mask at all times.

Covid Informed Consent    (new client . fill out online)
Initial New Client COVID Risk Questions    (new client. fill out online )
Pre-massage Covid Check In   (before each session. This form is sent to you via text msg or email the day before each appointment and much be completed to confirm your appointment)