RSVP 1 — Dr. Pearl Tin, DACM, L.Ac

Check Your Insurance Benefits

Many insurance plans do have acupuncture benefits. Our billing team is happy to check your coverage for you.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Full Date of Birth

MM

DD

YYYY

Insurance Carrier

Member ID #

Insurance Customer Service No.

Usually found on the back of the card

(###)

###

####

Name of Main Policy Holder (if different)

First Name

Last Name

Date of Birth of Main Policy Holder (if different)

MM

DD

YYYY

Additional Comments or Questions

Please submit your insurance information 72 hours before your first appointment. All information is kept strictly confidential and will only be used for verification purposes with your insurance company.