Victoria Brill

Choose clinic location

Appointment details

Are you a new or existing patient at this clinic

Choose a service Services are specific to each office

Reason for visit

Patient name

Email address

Phone number

Available times

Fri, May 20

No availabilities found on this day.

Sat, May 21

No availabilities found on this day.

Sun, May 22

No availabilities found on this day.

Mon, May 23

No availabilities found on this day.

Tue, May 24

No availabilities found on this day.

Wed, May 25

No availabilities found on this day.

Thu, May 26

No availabilities found on this day.

Fri, May 27

No availabilities found on this day.

Sat, May 28

No availabilities found on this day.

Insurance verification

Insurance Information

I am a provider for the following insurance companies: Regence Aetna Premera Kaiser Cigna United Health Care First Choice Some medicare plans (please call your supplemental insurance and see if I am listed on your plan as a provider) ALWAYS CHECK WITH YOUR INSURANCE COMPANY TO SEE IF YOUR PLAN COVERS MASSAGE AND THAT I AM A PROVIDER

If you want to use insurance for your visit please fill out the fields below so that we can verify your coverage

Name of Primary Insurance (Blue Cross, Aetna, Anthem etc.)

Insurance Type (HMO, PPO etc.)

ID # on insurance card The ID number on your insurance card

Group number

Insurance Provider Phone Number Located on back of insurance card

Claim address Located on the back of insurance card

City

ZipCode

State

Covered under someone else's insurance plan? Select "yes" if you are covered under someone else's insurance

Patient relationship to insured

First Name of Insured Party First Name of the primary policy holder

Middle Name of Insured Party Middle Name of the primary policy holder

Last Name of Insured Party Last Name of the primary policy holder

Insured Party Date of Birth Date of birth of the primary policy holder

Auto Accident? No-Fault / Personal Injury

Date of accident Please bring your authorization form to the office

Case/Claim #

Case Manager's Name

Case Manager's Phone #

Address to submit claims

I have read and accept the Terms of Use and Privacy Policy

© 2011-2022, Unified Practice, Inc. f.k.a.Chinese Medical Technologies, Inc. All rights reserved. The Unified Practice TM product, application, its components and various applicable related content and methodologies are proprietary to Chinese Medical Technologies, Inc., and are U.S. and International patent pending. The “Unified Practice” name, logo, and application icon are trademarks of Chinese Medical Technologies, Inc.