Insurance Verification

Let us check and see if your insurance covers acupuncture
We accept many insurance plans that cover acupuncture and complimentary alternative medicine, including all Auto Insurance. Just fill in the form below and we will be happy to verify your benefits and call you back.

Last Name: (required)

First Name: (required)

E-mail: (required)

Address: (required)

City: (required)

State: (required)

Zip: (required)

Phone: (required)

Referred By: (required)

Insurance Co: (required)

Insurance Co. Ph: (required)

Claim # if an accident: (required)

Date of accident/injury: (00-00-0000) (required)

Employer: (required)

Insurance ID. No: (required)

Insurance Name and ID #
if different than patient: (required)

Relationship to Insured: (required)

Group No: (required)

Insured DOB: (00-00-0000) (required)

Sex: (required)

Insurance Type: (required)

Condition or illness you are
seeking treatment for: (required)

Other Info:

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