When you are coming in for your first visit, print and fill out this paperwork and bring it in with you. Or come 10 minutes before your appointment to fill it out in our office.
- Registration and Intake form CAPCC (PDF)
- Financial Policy (PDF)
Please read over our Welcome Letter and sliding scale chart to know what to expect at our clinic.
- Welcome Letter (PDF)
- Sliding Scale (PDF)
Regarding reimbursement for insurance, flexible spending accounts, public housing, PIP claims, etc:
As a community acupuncture clinic, we do not have the resources to communicate with workplaces, government agencies or insurance companies on behalf of patients. We do not accept insurance and our sliding scale rates are equivalent or less than most co pays. We offer receipts at the time of treatment for patients wishing to submit information to these agencies on their own.
If you have access to these resources and are interested in reimbursement, you may fill out receipts at the time of service and submit them on your own to the responsible agency.
All medical record requests from legal firms and other agencies are subject to a $60 charge.
