Patient Intake Form
Please download, print and take time to fill out the Patient Intake Form and bring it with you to your first appointment. The information you provide will allow for a treatment plan to be designed specifically for you. It also gives us a baseline of where you are now so that we can evaluate what treatment will serve you better.
Download the Patient Intake Form
Insurance Billing Agreement
If you have insurance coverage for acupuncture, please download, print and take time to fill out, and sign the Insurance Billing Agreement and bring it with you to your first appointment. Please check your insurance policy to be sure of your acupuncture coverage, as I will have no access to your plan. I am on most of the BCBS plans, Aetna and United Healthcare, but please confirm that I am covered provider on your plan, how many treatments you are allowed per year, if there are any restrictions, such as "anesthesia only," and if you have met your out of pocket deductible for the year. If you have any other insurance plan, you will need to cover the cost of treatment and I can provide you with the detailed treatment receipt for possible reimbursement.
Download the Insurance Billing Agreement