Insurance Verification

If you would like to check your insurance benefits before scheduling an appointment, please fill out the form below. Be advised that form submissions will be electronically submitted through a non-HIPAA compliant server and there is a chance that the information could be accessed by outside parties.  If you wish to ensure your information is secure you may call 646.391-1717 to verify benefits.

Name *
Patient Date of Birth
Patient Date of Birth
ex. Aetna, United Healthcare, Empire, etc
ex. HMO, PPO, Anthen, etc.
Located on the back of insurance card
Select "yes" if you are covered under someone else's insurance
Name of the primary policy holder
ex. spouse, domestic partner, child
Any other information. Please let us know if your treatment is related to an auto-accident/no-fault, personal injury or workers compensation.

Dena Joyce Acupuncture

21 Portland Place, Floor 2, Montclair, NJ 07042    (646) 391-1717

Copyright © 2015 Vida Acupuncture, All rights reserved.