New Patient Form

It is suggested that new patients print this out and bring it to the office

First time Acupuncture

This provides basic information about the visit

NEW patients MUST check your  Acupuncture coverage before their first visit to use insurance benefits.

Call your insurance company

  1. Do your insurance cover for acupuncture?

    1. Do your pain or condition covered for acupuncture?
    2. Is Dr. Chou in your network provider?
    3. How many treatments do I get?
    4. How much is the co-pay for acupuncture from a preferred provider? 
    5. What percentage will I pay for out-of-network practitioners?
    6. Do I need a referral from an MD ?
    7. Do I need a prior authorization letter?
    8. What is my deductible?
    9. Do your conditions or pain are covered for acupuncture? Some plans may only cover the treatment of PAIN.
    Aetna Acupuncture policy maybe
    • Chronic (minimum 12 weeks duration) neck pain; or 
    • Chronic (minimum 12 weeks duration) headache; or
    • Low back pain; or
    • Nausea of pregnancy; or
    • Pain from osteoarthritis of the knee or hip (adjunctive therapy); or 
    • Post-operative and chemotherapy-induced nausea and vomiting; or
    • Post-operative dental pain; or
    • Temporomandibular disorders (TMD).
    • Check aetna to get the update information

    CIGNA Acupuncture policy maybe

    chronic pain conditions including headaches (i.e., migraine, tension), low back pain, neck pain, and osteoarthritic knee pain
    Check CIGNA to get the update information

    New Patient  office visit (20-30 mins)  Consultation /Office Visit / Exam / Herb Prescription
    • Discuss your goals and concerns
    • Diagnosis by traditional Chinese  Medicine method
    • Review your treatment options
    • Learn how the treatment works
    • Get any questions answered
     New Patient office visit and Acupuncture Treatment(75-120 mins) :  Consultation / Exam / Acupuncture / Auricular Therapy/ Hot Therapy
    Your initial visit will include an evaluation of your main complaints, examination of your health history, a brief physical exam, pulse and tongue TCM diagnosis, and you will receive your first integrated acupuncture treatment during this session.Your practitioner will also discuss and educate you on healthy practices to maintain your wellness, such as lifestyle changes, breathing exercises and/or nutrition. Integrated acupuncture treatment include consultation, electronic cupuncture, TDP or heat therapy, and auricular or ear seed therapy.

    • *Please download new patient form online or arrive 20 minutes early in order to complete all necessary paperwork.
    Follow-up (30-60 mins) : 
    This service is for Follow-up patients only. During this visit you will receive your follow-up acupuncture treatment.  Your practitioner will assess your progress and treatment plan. Your practitioner will also educate you on lifestyle changes, breathing exercises and/or nutrition.


    Your intake includes a full assessment of your current diet/lifestyle choices as well as a preliminary discussion on stress reduction You will walk away with a few powerful, specific recommendations to get you started.