Forms

The following forms will be useful to download, print, and sign before your first visit:

1. Review these forms, sign, and bring with you for your visit: Consent form, Notice of Privacy Practices, Notification of Scope of Practice

Download Consent/Privacy/Notification Forms

2. Fill out an intake form for yourself or your child, and bring it with you for your visit.

Download Adult Intake Form

Download Pediatric Intake Form

Policies

Cancellation Policy: We require 48 hours notice to cancel appointments and incur no fee. If you cancel within 48 hours or miss the appointment, you will be charged a $50 cancellation fee.

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.