Acupuncture and Herbal Medicine

Insurance Coverage Inquiry Form

Please fill out the form below and we will inquire with your medical insurance about coverage for acupuncture. We will not discuss any sensitive or confidential medical matters with the insurance company. Please provide the information below as it appears on your health insurance plan. Unfortunately we do not take any medicare plans at this time.

First Name:

Last Name:

Email:

Phone Number:

Date of Birth:

Address:

Insurance Company:

Policy Number:

Group Number:

Provider Phone Number:

Someone will get back to you within 24 to 48 hours regarding your coverage.