Forms & Fees

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

 

 

Policies

Cancellation Policy: We require 48 hours notice to cancel appointments and incur no fee. If you cancel within 48 hours , you will be charged a $50 cancellation fee. Missed appointments will be charged the full cost of the appointment. Of course let us know if there is an emergency, illness, or other extenuating circumstance.

PIP (Personal Injury Protection) Claims: We accept 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.

Fees:

Acupuncture & East Asian Medicine First Visit: $120

Includes health history / intake + treatment. Other modalities used may include: cupping, “moxa” (moxibustion), acupressure, gua sha, and craniosacral bodywork. Allow 60 – 90 minutes for first visit.

Acupuncture Return Visits: $120

Allow approximately 60 minutes for return visits.

These visits generally include Acupuncture and Craniosacral bodywork, as well as other modalities.

Facial Rejuvenation Acupuncture sessions now available as well. Feel free to inquire for more info.

Pediatric Acupuncture Return Visits are prorated based on time and are generally $75.

Full Craniosacral Visits: $135

Allow approximately 60 minutes for Craniosacral visits.

Pediatric Follow-Up Craniosacral Visits are prorated based on time and are generally $90.