Forms & Info

 

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: 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.