Insurance Receipt For Massage Clients – Fillable PDF


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This form is awesome!  It makes it so easy to just fill in the details on your phone, computer, tablet and send to your clients.

Who is this for?

This form is for therapists who don’t take insurance but provide receipts to their clients so their clients can submit the form to their insurance companies for reimbursement.


  • Saves time.
  • You can customize with your logo.
  • It auto-populates dates and totals.
  • Provides a professional look.
  • Is easy to use and save.
  • Has all the required information/fields health insurance companies need.


Just take a look at this video.

Works great with Adobe Acrobat Reader.  Get your free copy of Adobe Acrobat Reader here.  It’s the best way to work with PDF forms.

The insurance code for manual therapy is 97124.


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