forms and fees


3873 Piedmont Ave is on the west side of the street between Montell and Rio Vista–next door to Piedmont Systems and across the street from Pet Food Express. There is one flight of stairs to get to the second floor. Turn right at the top of the stairs and the office is the 1st door on your left.

Give yourself extra time to find parking–you can usually find unmetered neighborhood street parking, but you may end up several blocks away.  There is a lot of metered parking around the office, but if you haven’t left much time to look, the metered lot at 40th and Howe in front of the CVS is a good place to find a spot quickly.


Most forms can be filled out through the online patient portal. If you are unable to use the online interface for some reason, you can download these pdf forms to print, fill out, and bring to your appointment:


I am in-network with United HealthCare, plans that are managed by Optum, and Federal Employee Plans managed by Blue Shield. I will no longer be in-network with Anthem Blue Cross, Blue Shield, Aetna, or Healthnet after 2/24/23. I can still bill your insurance or offer a superbill if you have out-of-network benefits. If you want to use your insurance, it is important to submit your insurance information either by email or on the online patient portal ( prior to your first visit so we can verify your benefits.

  • Initial Consultation and Acupuncture Treatment* (90 minutes):
    • no insurance—payment at time of service: $130 
    • insurance: your coverage determines your co-payment + $40 fee for comprehensive initial intake + amount applied to deductible
  • Return Acupuncture Visit (60 minutes):
    • no insurance—payment at time of service: $90 
    • insurance: your coverage determines your co-payment + amount applied to deductible 
  • Cupping or Gua Sha** with your acupuncture treatment is an additional $30 
    • same with or without insurance since most in-network insurance does not cover these manual therapies
  • Initial Herbal Consultation (no acupuncture) 30-45 minutes: $80  
  • Return Herbal Consultation (no acupuncture) 20-30 minutes: $50