EN

Translate:

(626) 639-3887

  • Home
  • About
  • Clinic Forms
  • Sliding Fee Program
  • Services
  • Health Insurance Plans
  • Contact
  • Hipaa Privacy Notice
  • More
    • Home
    • About
    • Clinic Forms
    • Sliding Fee Program
    • Services
    • Health Insurance Plans
    • Contact
    • Hipaa Privacy Notice

(626) 639-3887

EN

  • Home
  • About
  • Clinic Forms
  • Sliding Fee Program
  • Services
  • Health Insurance Plans
  • Contact
  • Hipaa Privacy Notice
Wuxia Acupuncture Medicine

Health insurance verifcation

New Patient registration form

REQUEST FOR FINANCIAL ASSISTANCE UNCOMPENSATED SERVICES.

Please download and complete the charity screening form.  The completed form and documents are required for the screening process which can be brought into our office for verification.  

Financial Assistance form (pdf)

Download

Download HIPAA PRIVACY NOTICE

Our forms are encrypted when submitted.  They are HIPAA compliant and ensure that your privacy is protected.  Please download the notice for your own records. 


HIPAA Privacy Notice (pdf)Download

Copyright © 2014 Wuxia Integrative Medicine - All Rights Reserved.

  • Home
  • Clinic Forms
  • Sliding Fee Program
  • Services
  • Hipaa Privacy Notice

Powered by

Cookie Policy

This website uses cookies. By continuing to use this site, you accept our use of cookies.

Accept & Close