Scheduling Your First
Appointment:
If you would like to set up an appointment, please fill out the form below and we will get back to you within 24-48 hours….or for faster service you may call the office directly at 408-842-9688 OR TEXT 408-402-1805.
Prior To Your First Appointment:
Please print and fill out a new patient form to bring with you to your first appointment.
You may also fill it out once you arrive on your first visit.
NEW Heart Space Insurance Policy
As of June 2023, I am no longer in network with American Specialty Health and its affiliated insurance companies therefore full payment will be due at the time of service.
As a courtesy, my office will be happy to submit an insurance claim form to your insurance for you to be reimbursed directly. To help us obtain the correct information from your insurance card, please fill out the insurance verification form below so that we can have it ready for you on your first visit. You may also take a photo of the front and back of your card and text it to us @ 408-402-1805. Thank you.
Please note: Only the Acupuncture is billable to insurance as all other treatments are considered specialty treatments and not covered. Fertility AcupunctureTreatment falls under a “Specialty Treatment”.
Insurance Verification Form:
Worker’s Compensation Patients:
I do take Worker’s Compensation, but you will need a Doctors Referral as well as an Authorization from your Insurance Adjuster.
Please Fax your RX and AUTH to 408-842-1139 OR Email to acupunctureheartspace@gmail.com.
Once we receive this information, we will reach out to get you scheduled.