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Client Resources

Insurance and Prescription Forms

Complete your forms before your visit so your first appointment starts on time and your benefits are checked in advance.

Call 631-462-4263Text us

Rated 4.9 out of 5 on Google · Serving Commack and Long Island since 2000 · Recommended Community Provider for Memorial Sloan Kettering Cancer Center

How it works

  1. 01

    Choose your form

    Pick the form that matches your coverage: insurance, No-Fault or NYSHIP.

  2. 02

    Have your prescription ready

    Obtain your massage therapy prescription before completing an insurance form when required. Download the prescription form below to bring to your provider.

  3. 03

    We verify and contact you

    Our office reviews your benefits and contacts you about the next step. Insurance-based care is scheduled by phone or text, not online.

Choose the correct form

Please review the descriptions below before opening a form. Each form will open in a new browser tab so you can complete and submit it securely.

Health Insurance

Insurance form

Use this form when our office has instructed you to submit information for a health-insurance plan other than NYSHIP.

Have your insurance card and massage prescription available before beginning.
Open insurance form

Opens a secure form in a new tab.

Auto Accident

No-Fault form

Use this form when your massage therapy care relates to an automobile accident and will be submitted through No-Fault insurance.

Have your claim number, claims representative information, accident details, and prescription available.
Open No-Fault form

Opens a secure form in a new tab.

NYSHIP Members

NYSHIP insurance form

Use this form to provide the information and documents our office needs to review and verify your NYSHIP massage therapy benefits.

Obtain your prescription first. You will also need your insurance card, identification, and prescription when completing the form.
Open NYSHIP form

Opens a secure form in a new tab.

Provider Documentation

Prescription request form

Use this document when you need a form to share with your licensed healthcare provider when requesting a prescription for massage therapy.

Your completed prescription must include the required clinical and provider information before insurance benefits can be reviewed.
Download prescription form (PDF)

Prepare Your Information

Before you begin

  • Select only the form that applies to your insurance situation.
  • Have your insurance card and identification available when requested.
  • Obtain your massage therapy prescription before completing an insurance form when required.
  • Complete all required fields and upload clear, readable documents.
  • Contact our office before submitting a form if you are unsure which one applies.

Not sure which form you need?

Questions about a form or your coverage? Call or text 631-462-4263 and our office will walk you through it.

Call 631-462-4263 Text us

Serving Commack and Long Island since 2000

Helpful details

Insurance form questions

Direct answers about choosing the correct form and preparing the required information.

Which form should I use for health insurance other than NYSHIP?

Use the Insurance Form when the office has instructed you to submit information for a health-insurance plan other than NYSHIP. Have your insurance card and massage prescription available before beginning.

Which form should I use after an automobile accident?

Use the No-Fault Form when the massage therapy care relates to an automobile accident and will be submitted through No-Fault insurance. Have your claim number, claims representative information, accident details and prescription available.

Which form should a NYSHIP member complete?

Use the NYSHIP Insurance Form. Obtain your prescription first, and have your insurance card, identification and prescription ready when completing the form.

What is the Prescription Request Form for?

The Prescription Request Form is a document to share with your licensed healthcare provider when requesting a prescription for massage therapy. The completed prescription must include the required clinical and provider information before insurance benefits can be reviewed.

What should I prepare before completing an insurance form?

Gather the insurance card, identification and prescription requested for your situation. Complete every required field and upload clear, readable documents.

What should I do if I am unsure which form applies?

Call Hands On HealthCare at 631-462-4263 before submitting information. The office will help identify the appropriate form and explain the next step.

Does submitting an insurance form guarantee coverage or payment?

No. The information allows the office to review available benefits and requirements, but verification is not a guarantee of payment. Final coverage and claim decisions are made by the applicable insurance carrier.

Ready to schedule your care?

Insurance and medical massage appointments are arranged by our office.

Call 631-462-4263Text us
View insurance benefits