Payment
A superbill (an insurance claim form) is available after each treatment which may then be submitted to your insurance company. This allows us to devote more time and resources to you as a patient. We accept cash, personal checks, visa, discover, and mastercard.
Forms
For your convenience, we provide electronic copies of the forms that you will be asked to complete before your first treatment. If you would like, you can print them and fill them out ahead of time. Please note that all forms require the Adobe Acrobat Reader in order to display and print them. You can click the button below to obtain the Acrobat reader.
Forms:
Acupuncture
Notice of Privacy Practices
HIPAA Notice of Patient Privacy
Informed Consent for Treatment
Personal Data
Patient Health History
Facial Rejuvenation Acupuncture
Informed Consent for Facial Acupuncture (in addition to acupuncture forms)
Skincare
Skincare Intake Form
Peel Consent Form
Massage
Massage Intake Form
Endermologie
Endermologie Intake Form |