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TO VERIFY INSURANCE, PLEASE CONTACT YOUR INSURANCE COMPANY FIRST TO CONFIRM THAT YOU HAVE ACUPUNCTURE COVERAGE, THEN COMPLETE THIS FORM.

We will be in touch within 48 hours.

For inquiries or to schedule an appointment please contact:

located in Healing Haven Acupuncture & Wellness
2525 Camino del Rio South
Suite 245
San Diego, CA 92108

Name

First Name

Last Name

Email

Insurance Company

Member ID #

Group Number

Date of Birth

Provider Phone Number

listed on the back of insurance card

(###)

###

####

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