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CHECK YOUR INSURANCE BENEFITS

Please complete the form below, and we’ll be happy to check if your insurance covers acupuncture.

*Sorry, we are not in network with acupuncture policies managed by American Specialty Health.

Patient Name

First Name

Last Name

Patient Email

Patient Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Patient Phone

(###)

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DOB

MM

DD

YYYY

Gender

Insurance Company Name

Insured ID#

Insurance Company Phone #

(###)

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Message