Dori White Massage & Cupping
  • Home
  • About
  • Services
    • Cupping Therapy
    • Motor Vehicle Injuries - Insurance
    • Trigger Point Therapy
    • Deep Tissue Massage
    • Myofascial Release Therapy
    • Sports Massage
    • Swedish Massage Therapy
    • Hot Stone - Cold Stone
    • Lessons/Teachings >
      • Foam Roller Lessons
      • Stretching & Flexibility Lessoon
      • Release your Rotator Cuff Lesson
      • FAQ
      • Children's Sports Injuries
      • Health & Wellness Fairs - Corporate
  • Gifts
  • Contact
  • Appointments 2019/2020
  • Reviews

    New Patient Intake Form 


    On the chart below shade in the areas of your discomfort or concern, and number them in order of importance. 
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    Mark all that apply below
    Please list any medications, vitamins or supplements you use and what you use them for.
    If you answered YES to #2
    I understand that the above information will be kept in strict confidence and is provided to Dori White LMT in order to receive the best possible care and service.  I understand that Dori makes no medical claims and is not liable for any injury, health impairment or accident that may occur during my treatment.  

    24-Hour cancellation notice is required to avoid paying no show fees of half your scheduled appointment amount.

    "No-Shows" are charged the full amount of the missed appointment

    Late Arrivals , your session may need to be shortened to accommodate other clients who have made appointments.  You will be charged for a full session.

    Returned Check Policy, you will be charged $35.00 NSF fee.
    Thank you so much for selecting me as your massage therapist.  I look forward to meeting and working with you.
    Dori White, LMT
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Cupping Therapy and Massage Therapy

Dori White Massage & Cupping Therapy

9955 SE Washington St., Suite 303
Portland, Oregon 97216
Phone (503) 957-3696


Rediscover Your Healthy, Pain-Free Body!

Providing Massage Therapy for over 20 years, has been awarded "Best in Portland", offering several massage modalities. Specializing in  Cupping Therapy, Deep Tissue Massage Therapy, Motor Vehicle Injury R
ehabilitation, Myofascial Release, Trigger Point Therapy, Swedish Massage, Relaxation Massage, and more.

Dori White has been a Portland Massage Therapist offering massage therapy since 1998.   Lic. #6904
  • Home
  • About
  • Services
    • Cupping Therapy
    • Motor Vehicle Injuries - Insurance
    • Trigger Point Therapy
    • Deep Tissue Massage
    • Myofascial Release Therapy
    • Sports Massage
    • Swedish Massage Therapy
    • Hot Stone - Cold Stone
    • Lessons/Teachings >
      • Foam Roller Lessons
      • Stretching & Flexibility Lessoon
      • Release your Rotator Cuff Lesson
      • FAQ
      • Children's Sports Injuries
      • Health & Wellness Fairs - Corporate
  • Gifts
  • Contact
  • Appointments 2019/2020
  • Reviews