Restore Balance To Your Life & Body
Once we verify your insurance (and before you come in for your appointment), you will need to download and complete the Intake Form, Consent & Advisory Form & Policies. Please bring both forms and your insurance card with you to your first appointment.
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!
Please fill out the following form and click Submit. We will call you back with your benefits and will set up your first appointment.
If you are a new patient to Acupuncture and Wellness Center and are looking to book an acupuncture appointment, please call 443.219.1220 or email firstname.lastname@example.org and we will be happy to speak with you about setting up an appointment, discussing any needed paperwork and contacting your insurance company to find out your acupuncture benefits.
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+1.443.219.1220 • 8813 Waltham Woods Road Suite 102 Parkville MD 21234 US