New Client Info
If this is your first session with us OR if it has been over a year since you last came in, please follow the instructions below.
If you are treating with Mandi, Brian, or Angel, they have their own intake forms and process, so please reach out to them directly.
Here are just some of the things that our highly skilled practitioners can help you overcome:
Headaches
Neck pain
Shoulder pain
Back pain
Hip pain
Knee pain
Ankle pain
Foot pain
Posture issues
Repetitive motion issues
Jaw pain (TMD or TMJ Dysfunction)
Frozen shoulder
Tennis elbow
Carpal tunnel syndrome
IT band syndrome
Patellar tendinosis
Plantar fasciitis
Shin splints
Range of motion
Uneven gait
Chronic pain
Acute pain
Post surgical rehab
Over pronation
Over supination
Muscle tension
Scoliosis
Lordosis
Kyphosis
Myofascial pain
New Client Forms
Please bring these COMPLETED forms with you to your first session. If you need to fill them out at the office, notify your practitioner well in advance to allow for the extra time so it won’t shorten your session.
Health History
(2 pages)
Client Agreements
(2 Pages)
Insurance Forms
If we are billing your insurance AT ALL (even just to eat up your deductible, you MUST bring us the completed and signed form below.
What your health insurance will likely cover
This is general information regarding health insurance.
We will have to check your plan to know exactly what the limits of your plan are. As a courtesy we can bill your health insurance directly, but that is not a guarantee of payment. Additionally, rates that we bill insurance are different than the rates we charge for payment at the time of service. Due to insurance coverage rules, we cannot deduct insurance payments from the cash rate.
- Rolfing is a brand name, so it’s not a term that insurance companies recognize, so we use billing codes for “manual therapy” (typically under physical therapy benefits) and “massage therapy” (typically a separate benefit), plus a few other codes as necessary.
- Frequently physical therapy benefits are combined with occupational therapy and speech therapy. Sometimes, they are also combined with chiropractic and/or acupuncture. IF ANY OF YOUR PROVIDERS ARE BILLING UNDER THE SAME CATEGORY WE BILL UNDER, WE NEED TO KNOW.
- If for any reason your insurance deems your care as not medically necessary, you will need to pay the “time of service” rate, which is $220 per session.
- Even though we check your benefits, insurance companies frequently do not accurately give us coverage or fee schedule information, so we can’t know for certain about your coverage until after we bill.
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If your deductible has not yet been met, you will need to pay the “time of service” rate of $220 per session. As a courtesy we can still bill your insurance, and whatever coverage you have may be applied to
your deductible, but this is up to your insurance company.
- Insurance companies pay according to their own fee schedule, which is not based on what providers charge. This is called an “allowable” amount. For example, if your insurance pays 80%, that is 80% of what they allow, not 80% of the amount charged by your provider.
- Most health insurance companies typically limit the number of codes billed per day. Rolfing sessions are 75-90 minutes, but most insurance covers 60 minutes. Therefore, we can only bill the insurance for 60 minutes, and then you are responsible for the additional time, which is $110. IF YOU ARE SEEING ANOTHER PROVIDER ON THE SAME DAY WHO IS BILLING THE SAME CODES, THEY WILL NOT COVER BOTH PROVIDERS.
- Some insurance companies require pre-authorization and/or referrals in order to pay. This can take up to two weeks for us to receive.
Other insurance info:
- ANY of us can bill insurance for a motor vehicle accident or worker’s compensation claim. We will need a prescription written VERY specifically, and we need to discuss this in detail (ask Jenny).
- Jenny is IN NETWORK with Blue Cross Blue Shield, MODA, and Providence.
When covered, we can bill your insurance company for you. However most plans won’t cover the entire session. - Deductible, copayments, co-insurance. and add-ons are your responsibility.
- Billing your insurance is not a guarantee of coverage, you are ultimately responsible for payment.
- We are NOT providers for: Cigna, United Healthcare, Kaiser, Aetna, GEHA, OHP, Medicare, or Medicaid (and others). These companies either won’t allow us, or pay so little that we cannot afford to be contracted with them.
- IF you have out of network benefits, we can provide you with a Superbill so that you can submit for reimbursement.
Please use this link if you want us to verify your insurance coverage prior to your appointment. If can take up to 7-14 days to do this.
Insurance Coverage Verification
As a courtesy Body Balance will bill your insurance, but YOU are ultimately responsible for the payment.
We need at least 10 days to verify your benefits. All information is kept strictly confidential.
We accept cash, debit or credit cards. Some of us can take Venmo or Zelle. We can also provide receipts for your taxes or for your Flexible Spending Plan (Benny card) or Health Savings Account (HSA). Most of these plans have a debit card that we can also process.
Fees vary based on practitioner and type of service, so there is no good way to list all prices here. Most of this information is listed on the scheduler BEFORE you commit to an appointment. Please contact your provider directly if you have more questions.
HIPAA Privacy Policies
Do NOT bring this with you. This is only for you to have.
Jenny Rock
Certified Advanced Rolfer™
Shockwave (ESWT)
Medical cold laser
Kinesio® Tape
503-890-9365
jenny@bodybalanceportland.com
Michael Valenti
Certified Advanced Rolfer™
503-966-8433
michael@bodybalanceportland.com
https://rolfology.com
James Jacoby
Massage Therapy
Laser Fat Reduction
775-230-2460
james@bodybalanceportland.com
https://www.massagemepdx.com
Michele Wren
Structural Integration
Massage Therapy
503-730-2869
michelewren@yahoo.com
Mandi Trimas
Acupuncture & Herbs
Cupping
Gua Sha
Moxa
503-575-9740
bluehorizonacupuncture@gmail.com
https://www.bluehorizonacupuncture.com
Brian Cameron
Acupuncture
Massage Therapy
Cupping
Gua Sha
860-538-5939
luckyrabbitacupuncture@gmail.com
https://luckyrabbitacupuncture.com
Angel Ray
Massage Therapy
Counseling
503-470-2626
angel@angelraymassage.com
https://www.angelraymassage.com
http://www.angelraycounseling.com
Sessions by all practitioners are by appointment only.
Click the link for “TEAM” to schedule with anyone in the office.