Insurance Verification

Eastern Integrative Health (Mitchell Harris LAc) is covered as an In-Network provider for Amita Health HMO and Blue Cross Blue Shield PPO. All other insurance carriers may have Out-of-Network policies for acupuncture, which can also be billed by our office for your reimbursement.

Please use this form to send us your insurance information and we will get back with you for the best options for your acupuncture care. It only takes a minute to fill out!

Step 1 of 2

Patient Information

Employer's Name

Name *

First

Middle

Last

Date of Birth *//

Gender

Preferred Method of Contact

Phone number *

E-Mail *

Chief Complaint or Primary Diagnosis

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Insurance Verification

Patient Information

Insurance Information

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