Acupuncture | Baltimore | Acupuncture & Wellness Center
Restore Balance ​To Your Life & Body

New Patient Form

STEP 2:
​Once we verify your insurance (and before you come in for your appointment), please download and complete the IntakeConsent, & Office Policies Form. Please bring completed documents and your insurance card with you to your Initial Visit. 
Questions or concerns? Call the office at (443) 219-1220

New Patient

STEP 1:
​Please fill out the New Patient Form and click Submit. We will contact you as soon as possible with the quoted coverage from your insurance company and to schedule your Initial Visit.

​Please make sure to complete ALL sections with an * in order for the form to be submitted correctly. You will be prompted if a section is not completed. If all sections are completed correctly, the SUBMIT button will turn a bright blue and allow you to click submit. Thanks!

If you are a new patient to Acupuncture & Wellness Center and are looking to book an acupuncture appointment, please call 443.219.1220 or email donnadegnanlac@gmail.com. We will be happy to speak with you about setting up an appointment, discussing any needed paperwork, and completing a courtesy insurance verification to find out if your plan carries any acupuncture therapy benefits.

Acupuncture ​Appointment