Forms to Complete
*FERTILITY PATIENTS: Please note that you have an extra form to complete, outlining your fertility history
*INSURANCE PATIENTS: PLEASE NOTE THAT IF YOU WISH US TO BILL INSURANCE, YOU MUST ARRIVE WITH THE LAST FORM COMPLETED, SO THAT YOUR INSURANCE HAS BEEN VERIFIED BEFORE YOUR VISIT. OTHERWISE WE WILL JUST ASSESS THE SELF-PAY RATE UNTIL THE TIME AT WHICH YOUR COVERAGE HAS BEEN VERIFIED.
Acupuncture Treatment Forms (All Patients):
- New Patient Initial Intake Form
- Consent To Receive Treatment & Cancellation Policy
- Colorado Mandatory Disclosure Statement
- Covid-19 Consent/Release from Liability
Fertility Patients Extra Form:
**please note that we only work with women who are rying to get pregnant naturally, and their male partners for male factor fertility — if you will also be starting ART/IVF please schedule with Rachel Blunk instead.
For Patients Wishing to Bill Insurance:
Complete this form by calling your insurance and asking the questions provided, and bring it to your first acupuncture appointment along with your insurance card. If you do NOT arrive at your first appointment with this form completed, we will simply apply the self-pay fee at the time of your visit, until the time at which your coverage has been verified
*Please note that even if your plan includes acupuncture benefits, some plans only cover limited conditions*