Forms, Fees, and Insurance

Forms

Health History & Consent (4 pg. pdf)
Acknowledgement of Privacy Practices (1 pg. pdf)
Scope of Practice (1 pg. pdf)
Notice of Privacy Practices (3 pg. pdf)

Insurance

Earth and Sky Healing Arts is contracted as a preferred provide with only one health insurance network:

First Choice Health Network

If you are part of this network, please contact your insurance company and complete the insurance verification form with a representative over the phone. This will enable you to clearly determine the degree of coverage by your provider.

Insurance Verification Form (1 pg. pdf)

If you are not part of this network, we are able to submit a receipt electronically to your insurance company and they will reimburse you directly for the coverage agreement for out of network practitioners. Payment is due at the time of treatment. Though we are able to bill your insurance company as a courtesy to you the ultimate financial obligation belongs to you and not your insurance company.

Fees

We accept payment at time of service. The fee structure is based on treatment time. We can discuss this at your first visit.

There may be additional fees for use of other modalities including tui na, heat lamp, gua sha, moxa and cupping. Please note that insurance does not cover the cost of herbs.

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Cancellation Policy

We require 24 hours notice to cancel appointments and incur no fee. If you cancel within 24 hours or miss the appointment, you will be charged a $50 missed appointment fee. Please be advised that insurance does not reimburse for missed appointments.

SuperUser2016@WPForms, Fees, and Insurance