60 minute session: $115
Longer sessions are available on request.
Payment is expected at the time of treatment. Cash, check, and credit cards
(Visa, Mastercard, American Express, Discover) accepted. Health Savings Accounts (HSA) and
Flexible Spending Accounts (FSA) can also be used as forms of payment.
Please give at least 24 hours notice if you wish to cancel your appointment. Other patients may be
waiting for an appointment. There will be a $50 charge for appointments cancelled with less than
24 hours notice.
In order to provide quality one-on-one care for the entire treatment session, Restrictions
Released Myofascial Therapy is not an in-network insurance provider. If your insurance is a
Preferred Provider Organization (PPO) you may be able to receive some reimbursement from your
insurance provider, however if you have a Health Maintenance Organization (HMO) you would not be
able to submit for reimbursement. If you have a PPO we recommend you contact your insurance
company to determine the specific details of your plan for seeing an Out-of-Network Physical
Therapist. Some plans many require you meet an out-of-network deductible and only reimburse a
percentage of the cost. If you do have out-of-network coverage you would pay for the full cost of
the session at the time of service and then you would receive a bill from Restrictions Released
Myofascial Therapy to submit to your insurance company for reimbursement. We can discuss this
further during your first visit if you plan to seek reimbursement from your insurance company.
An FSA is a financial account that can be set up through a cafeteria plan of an employer, where
the employee can designate pre-tax dollars to be put towards medical expenses. If you would like
to submit a receipt to your FSA please request a bill for services.
Completed intake forms
Download the forms above. If you are unable to complete new patient forms
in advance please arrive 10 minutes prior to your scheduled appointment to complete them in
What to wear
The nature of fascial restrictions is a whole body problem so we treat whole body. In order to
fully assess posture and treat all of the areas of fascial restriction it is important to have
much of the body exposed. Men please wear or bring gym shorts. Women please bring gym shorts
and regular bra or tank top.
What not to wear
Please do not wear any body lotion the day of your session. In order to receive the most
benefit from the therapy your skin must be clean and dry to allow the therapist to properly
access your fascial system.
Some patients like to take before and after pictures of their posture to document their
progress. Some patients also like to have photos or videos of themselves performing the self
treatment exercises as a reminder on how to properly do them when at home.
Your first appointment will consist of a Physical Therapy evaluation which will take approximately
30 minutes and the remaining time will be hands-on treatment. Once it is determined where your
fascial restrictions are, you will be instructed on some self treatment exercises. Patients will
be given small balls to assist them in releasing the fascia at home. Self treatment is a very
important part of the treatment plan. It is also important to drink plenty of water after your
session, this will help the releases to last longer.
It is strongly recommended that new patients schedule at least 3 sessions (once a week for 3
weeks). Three sessions are needed to begin a proper treatment plan. Most patients will see some
results after the third session.
Under Massachusetts state law Physical Therapists are granted direct access to patients. You do
not need a prescription from a doctor to see a physical therapist. However your insurance company
may require a prescription if you plan to submit a bill for reimbursement.