The following forms will be useful to download, print, and sign before your first visit:
1. Fill out an intake form for yourself or your child, and bring it with you for your visit.
Download Intake Form
2. Review these forms, sign, and bring with you for your visit: Consent form, Notice of Privacy Practices, Notification of Scope of Practice
Download and Sign Consent Form
Download and Sign Scope of Practice Notification Form
Review Notice of Privacy Practices
Cancellation Policy: Due to the extenuating circumstances of the pandemic, we are waiving cancellation fees at this time.
PIP (Personal Injury Protection) Claims: We accept many PIP claims for auto accidents. Please provide the following information before your first appointment:
- Date of accident
- Claim number
- Insurance claims adjuster’s contact information
- Attorney’s contact information (if applicable)
Superbills/Receipts: We are happy to provide a receipt which you can submit to your insurance company for reimbursement. Please check your healthcare plan to make sure you have coverage for acupuncture and out-of-network provider coverage.
If you would like a Superbill for Craniosacral treatments, you will need a Massage Prescription dated prior to the first date of service. Insurance billing requires a medical diagnosis and currently Massage Therapists cannot diagnose for a medical condition. Even though it is in my scope of practice to diagnose certain conditions for Acupuncture, I cannot diagnose when doing Craniosacral / Massage Treatments.
Acupuncture & East Asian Medicine First Visit: $120
Includes health history / intake + treatment. Acupuncture sessions use gently placed filiform needles at specific points in the body. Other modalities used may include: cupping, “moxa” (moxibustion), acupressure, gua sha, and craniosacral bodywork.
Acupuncture Return Visits: $120
These visits generally include Acupuncture and Craniosacral bodywork, as well as other modalities.
Facial Rejuvenation Acupuncture sessions available as well. Feel free to inquire for more info.
30 Minute Pediatric Acupuncture Return Visits: $75
Craniosacral Visit: $135