Form at NC Raleigh Acupuncture

Please click here to open a printable version of the Patient Record form. You can fill it out before your first visit.

Please note: the Patient Record Form requires the Adobe Acrobat PDF Reader, which can be downloaded from the Adobe web site.



Payment is required at the time of service by cash or check. We require the payment directly from you; but we will give you the paperwork needed to get the reimbursement you are entitled to depending on the type of insurance carrier that you have. If needed, we will gladly write supporting information to your insurer at no charge to you. Our fee schedule is at your request.



Appointments that are cancelled less than twenty-four (24) hours in advance will be subject to a charge of  $30.00



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