Acupuncture in Boca Raton & Deerfield Beach, Serving South Florida's Broward and Palm Beach Counties.

Acupuncture - Boca Raton - Deerfield Beach

Please fill out this Insurance Verification form.

Patient First Name*
Patient Last Name*
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Patient Address*
Patient Phone Number*
Email*
Patient Date of Birth*
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Patient Subscriber/ID Number*
Group Number*
Insured Name & ID Number (if different from patient)
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Insurance Company Name*
Insurance Company Phone Number*
Claim Number (if an auto accident or workman's comp)
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Click here to download a PDF version of the Insurance Verification form to be filled out and faxed back.

You may be able to receive Acupuncture even though your plan does not have Acupuncture Benefits available. Our trained staff will determine your benefits and respond promptly to your information. We have successfuly processed claims from Insurance companies such as United, Cigna, Aetna, Coventry, Blue Cross / Blue Shield, Empire and Humana to name a few. We also accept PIP Personal Injury Protection from Auto Accidents and Workers Compensation.

Privacy Policy: By submitting this form, I understand that my personal information will be used initially for the insurance verification process. Once a scheduled consultation and treatment has been conducted, your information may be used for billing your insurance company for payment of services rendered. The information will be accessible to Tony Willcox and his staff. I understand that I have the right

Acupuncture Now - Boca Raton - Medical Team Panthers

561.274.4447