Patient Forms

We bill insurance if you have acupuncture benefits!  We are in-network with BlueShield PPO and out-of-network with all other insurance companies.  We will check your insurance benefits!  

Please email your insurance information including: name, date of birth, name of insurance, ID and group numbers.

If you are a NEW PATIENT, please print, complete and sign all forms and bring them to your appointment.

Patient Intake Form Cancellation Policy & 

Payment Responsibility
Arbitration Agreement &

Acupuncture Informed Consent to Treat
Consent Liability Form