Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone Number *

(###)

###

####

Which provider(s) would you like to see? *

Choose 2 for the most flexible option

Dr. Aaron Lee (Licensed Acupuncturist - He/Him) - English

Dr. Eric Sun (Licensed Acupuncturist He/Him) English, 普通话流利

Dr. Kevin Tai (Licensed Acupuncturist He/Him) English, 普通话和粤语流利

Dr. Jessica Brophy (Licensed Acupuncturist She/Her) English, 流暢な日常会話ができる日本語

Dr. Gahwi You (Licensed Acupuncturist She/Her) English, 한국어에 능통하다

Pamela De Guzman (Massage Therapist She/Her) English

Robyn McIntire (Massage Therapist She/Her) English

Day and time best for an appointment: *

Choose the best block and day that work for your schedule

Early Mornings 9AM (Only available on Sat/Sun)

Morning 10AM-12PM

Afternoon 12PM-4PM

Early Evening 4-6PM

Mondays

Tuesdays

Wednesdays

Fridays

Saturdays

Sundays

Any, call for availability

Insurance Benefits Disclaimer: Most benefits require that the chief complaint be a "covered condition" under the health plan's medical policy bulletin for acupuncture. Covered conditions are 99% related to musculoskeletal conditions like neck and low back pain, shoulder pain, arthritis, etc. and very rarely cover Fertility Treatments, Pelvic Floor Disorders, Relaxation and Mental Health Disorders. Do you understand that if your chief complaint is not billable or covered, that you may need to pay out of pocket for a treatment. We will be more than happy to provide you a superbill if this is the case. *

Yes

No

Massage Therapy is not a covered insurance benefit by ANY health plan, other than Worker's Compensation and Auto Injury. Do you understand that in order to book a massage, you will need to pay out of pocket for your service? If yes, please call in for pricing and full deposit for treatment. *

Yes

No

Verification of benefits are not a guarantee of payment or coverage, all coverage and benefit limits will be determined once the insurance claim is paid out. Do you understand that by using your insurance benefits, there is a risk that you may need to pay out of pocket for your entire treatment? *

Insurance coverage is a confusing and complex field, the statement listed above is the standard statement that insurance tells us as providers, we are only passing this statement along to you.

Yes

No

Quick Office Policy Rundown: Credit Card on file is required at the time of booking. If you do not have a valid credit card, we will still book you in, but if you miss your first appointment (unless due to emergency) you will no longer be allowed to be seen at our clinic. Late cancellations are less than 24 hours and late reschedules are 12 hours or less, your first late cancellation/reschedule will be a warning, but future ones will incur a $100 fee. Do you understand? *

Yes

No