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About Us
Our Team
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Our Clinic
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All Therapies
Acupuncture
Herbal Medicine
Cupping
Bodywork
psychotherapy
What We Treat
Blog
What To Expect
FAQs
Insurance & Pricing
Contact
Info
Job Opportunities
Grievance Form
Community Engagement
Events
Community Partners
Accessible Holistic Healthcare
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Verification of Benefits
*
In order for us to send your benefits for a full verification of cost, deductible, etc.. - we need to know that you have acupuncture benefits. If you have not done this, please call the number on the back of your card to confirm first, then fill out this form.
I have confirmed I have Acupuncture Benefits with BCBS
Name
*
First Name
Last Name
Email
*
Phone #
*
(###)
###
####
Insurance Company
*
DOB
*
MM
DD
YYYY
Insurance ID# Including Letters
*
Group # Including Letters
*
Insurance Customer Service Phone # (on back of card)
*
(###)
###
####
How would you like to be contacted once we confirm?
*
Phone
Email
Thank you!