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New Patient Questionnaire

Herbal Questionnaire

Office Policies

 

Appointments: All patients are seen on an appointment basis. Please call well in advance so we can reserve time for you. Please be aware that the full treatment fee will be charged for broken appointments unless a 24-hour business day notice is given. This means for a Monday appointment notice needs to be given by Friday at 12:30 PM. It is the patient’s responsibility to remember an appointment.  Reminder calls or text messages are made only as a courtesy.

Waiting list: On many occasions we have a waiting list for patients that want to come in sooner than scheduled. If you would like to be placed on the waiting list please let the receptionist know.

Payments: We make every effort to keep the cost of care down. To assist this effort, you are expected to pay upon the completion of each visit. We accept Visa and Master credit cards, debit cards, checks or cash. We request a $20 minimum purchase for credit card charges.  A $25.00 fee will be charged on all returned checks.

Emails: Email has been very helpful for our patients in answering health related questions efficiently between visits and there has been such a demand for this option that we are now charging $10.00 per 5 min increment for the time it takes us to respond. Please note emails are unencrypted methods of communication and deemed “unsecure” by Federal law (HIPAA). It is up to each patient to weigh the tradeoff between convenience and security.

Chinese herbal formula refills: We kindly request a minimum of a 24 hour notice for herbal refills.

Insurance: We do not bill insurance. We will be happy to assist you with filling out any relevant insurance claim forms but payment is expected after each visit. After filing your claim, your insurance carrier may reimburse you. Acupuncture is covered under Health Savings Plans and some Medical Savings Accounts. Chinese herbs and supplements are not covered under any insurance plan.

Medical records receipts: Upon request, we provide a superbill at each visit that has all the information you need to file for insurance reimbursement. It is your responsibility to request and keep track of all your paperwork. Any additional requests for billing-related paperwork (e.g. year-end billing summary) will incur an administrative fee of $25.

Thank you for calling this office. It is a pleasure to be of service to you.