Allied Health Care - Day Spa / Massage Terapy Supplement

Allied Health Care – Day Spa : Massage Terapy Supplement APP PDF Download

Allied Health Care - Day Spa / Massage Therapy Supplement

  • Type of ServiceAnnual Number of ProceduresName and Job Title of Person Performing Procedure 
    (Please click the plus button to each additional service)
  • 3) If any of the applicant's services involve the following, please note in the space provided the number of procedures over the past 12 months:
    If "Yes"
  • Percentages of all chemical peel services:

  • This supplemental application is incorporated into and is deemed a part of the other application(s) submitted in connection with the requested insurance. any and all notices and representations included in such other application(s) are incorporated by reference in this supplemental application as though fully set forth herein.

  • (Please type full name in space provided)
  • (Principal, Partner or Officer)

    (Please use your mouse on a PC or Mac, or your finger or stylus on a tablet or smartphone to sign your name.)

  • MM slash DD slash YYYY
  • (Required in New Hampshire)
  • This field is for validation purposes and should be left unchanged.