Zoetic Acupuncture

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Reason for visit

Patient name

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Available times

Fri, Dec 3

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Sat, Dec 4

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Sun, Dec 5

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Mon, Dec 6

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Tue, Dec 7

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Wed, Dec 8

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Thu, Dec 9

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Fri, Dec 10

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Sat, Dec 11

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Insurance verification

Insurance Information

We are currently an in-network provider for Blue Shield of California, OptumHealth, and UnitedHealthcare. We will verify your insurance coverage (both in- and out-of-network) for free. Please fill out the insurance verification form below and allow 48 hours for verification.

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

Cancellation Policy

Entering a payment method is required to complete the booking of your appointment. If you cancel your appointment within 24 hours of its scheduled start time, your credit card will be charged a late cancellation fee of $ .

If you need to cancel or reschedule your appointment please email us at info@zoeticacupuncture.com or call/text us at 415-580-0808. Thank you.

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