New Patients: Please complete the new patient forms below and bring them with you to your first appointment. If you are not able to get them finished ahead of time please plan to arrive 30 minutes early. We know the forms are lengthy but it allows us to get the information we need to treat you and focus on your current concerns at the initial appointment. If you are unsure which forms to fill out please select the practitioners tab at the top of the page, select the practitioner you are scheduled with, print and fill out the HIPAA & Financial Responsibility form as well as the appropriate Intake form at the bottom of their page. If you have any questions, please give us a call!
On the day of your appointment please bring with you photo ID as well as your insurance card if we are billing your insurance.
|Vaccine Intake||1/28/2018||Download Preview|
|Physical Therapy - Pelvic Intake||2/4/2018||Download Preview|
|Physical Therapy - Ortho Intake||1/28/2018||Download Preview|
|Pediatric Intake||1/28/2018||Download Preview|
|Naturopathic Intake||1/28/2018||Download Preview|
|Massage Intake||12/4/2017||Download Preview|
|HIPAA & Financial Responsibility||1/28/2018||Download Preview|
|Chiropractic Intake||1/28/2018||Download Preview|
|Acupuncture Intake||1/28/2018||Download Preview|
Cancelation Policy: Please be aware that we ask patients to give us 48-hour notice if they need to reschedule or cancel an appointment. Late cancellations or missed appointments incur a $45.00 fee or greater, as we are unable to reschedule the appointment with another patient without sufficient notice.
Parking & Accessibility: We are located just west of the intersection of NW 23rd on NW Flanders (between 23rd & 24th Ave.). Parking is available in the main and lower lot; please do not park below the building in the covered area. There is also metered street parking throughout the neighborhood. Wheelchair access for the first floor is located through the main level parking lot. Please come a few minutes early and enjoy a cup of tea before your appointment.
Insurance: Our clinic accepts most insurance plans. As a courtesy, Kwan-Yin Healing Arts Center will bill your insurance on your behalf. Insurance information given to Kwan-Yin Healing Arts Center by your insurance company is not a guarantee of payment. This includes information provided about covered treatments, copays, coinsurance, deductibles, and pre-authorizations.
It is your responsibility to read your own policy, know your coverage, and review explanation of benefits statements regarding payments. Please remember your insurance policy is an contract between you and the insurance company, we cannot guarantee payment of your claims It is ultimately your responsibility to pay for any balance not paid or covered by insurance. Any charges that are not covered by the given insurance company will be billed to you.
Below is a list of some procedures codes that may not be covered by your insurance, but may be necessary during the normal course of an examination to diagnose, evaluate and give you the care you need.
97140: Manual Therapy (Billed out for Maya Abdominal Therapy)
97014: Electric Stimulation
97035: Therapeutic Ultrasound
97810: Initial 15 minutes Acupuncture
97811: Additional 15 minutes Acupuncture
99354, 99355: Prolonged Services
99358: Additional Research Outside of the Office Visit
A decline of these treatments must be made acknowledged in writing prior to the services being performed.