Insurance Verification
The following information is needed to verify your acupuncture benefits. All responses are confidential and not seen until submitted.
Email address *
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Insurance Company Name *
Your answer
Membership ID# (please include all letters if any) *
Your answer
Type of Plan (optional)
Your answer
Phone number if contact by phone is preferred, otherwise you will receive an email response of your insurance acupuncture benefits (optional)
Your answer
Comments (optional)
Your answer
Thank you for your response. Please allow 2-3 days to receive your acupuncture benefits.
All responses are confidential and not seen until submitted. Sun Cho Acupuncture
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