Please complete

Professional Clinic Intake Form

Make an Appointment

We accept insurance from providers such as Blue Cross, Blue Shield, and United Healthcare. In order to ensure that your health plan covers the services provided by our Clinic, please inform us at the time you schedule your appointment of which insurance or health plan you wish to use. This will allow us to obtain confirmation of your eligibilty to use your insurance plan to cover your treatments. In order to assist in verifying your eligibility for insurance coverage for acupuncture, please fax/email the following items to us at least 48 hours before your first appointment:

1. An enlarged copy of the front and back of your insurance card;
2. Your social security number;
3. The health condition for which you are seeking acupuncture;
4. Your full name and telephone number;
5. Your date of birth; and
6. If the insurance policy holder is someone other than yourself, we will need their date of birth.

Our fax number is (512) 707-8866; please call us at 512-445-2222 before you fax, so that we can contact you to confirm receipt. If you have any further questions, please contact us at clinic@austinacupuncture.com.

Please note that this is a request form. You will receive communication from our clinic to confirm your appointment. If you do not receive one within 24 hours of sending your request, please email clinic@austinacupuncture.com or call

512-445-2222.