Acupuncture Insurance Verification Form

We accept many insurance plans that cover acupuncture and complimentary alternative medicine.  Just fill in the form below and we will be happy to verify your benefits.

By submitting this form, I understand that my personal information will be used ONLY for the insurance verification process. It will be accessible to Sunshine Integrative Health, Inc. and to a third-party biller. I understand that I have the right to request any and all restrictions to the use of disclosure of my health information.

* First Name

* Last Name

* Insured DOB

* Address

* City

* State

* Zip Code

* Phone #

* Email Address

* Insurance Company

* Insurance ID/Policy#

* Insurance Group #

* Insurance Company Phone

Referred by

* Please type the numbers from above..