Insurance Verification
Please fill out the following form so we can check if your insurance covers acupuncture. We will get back to you in a timely matter. If you have any other questions, feel free to email aquariusacupuncture@gmail.com

Have a great day!

Aquarius Acupuncture, PLLC
www.aquariusacupuncture.com
80 East 11th Street, Suite 309
New York, NY 10003

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First Name *
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Last Name *
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Date of Birth *
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Mailing Address (street address, apt number, city, state, zip code) *
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Insurance Name *
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Insurance 800 # (this is the provider phone number located on your insurance card) *
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Insurance Member ID # *
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Preferred Practitioner (optional)
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