Insurance Benefits Check Form

Many people have acupuncture coverage under their insurance. Before you come in for your first appointment, as a courtesy to you, we will gladly research your insurance coverage. However you will be responsible directly to Wheels Darling for full payment of your account if your insurance company does not extend coverage for services. This form will need to be submitted at least 24 hours in advance of your treatment.

Name *
Date of Birth *
Date of Birth
Often on the back of the card