Patient Forms

New Patient Intake Form

Fill out this form and bring to your first treatment.


Patient Referral Form

For Doctors and other health specialists. If a patient is not responding to conventional treatments adequately, acupuncture can be utilized as a combined approach to speed up recovery.


Acupuncture and Insurance Worksheet

Your insurance carrier may pay from 20-50% or more of the cost of your acupuncture treatment. Use this form to help you when you contact your insurance company to inquire about treatment coverage. After paying the acupuncturist for your treatment, you would then submit a claim form to your health insurance company for reimbursement. Each insurance policy is different, so it is important to call the insurance carrier to find out if acupuncture is covered, what percentage they will pay and how to file a claim. Take advantage of this benefit!



Milwaukee Acupuncture