Welcome to The Local Healer!
This is not our intake form. You will find those in our patient portal, and we'll need you to fill those out online before your appointment.
Please verify your acupuncture benefits by downloading this form, calling your insurance company, filling it out and bringing it to us at your first appointment. As you are ultimately responsible for covering the cost of your visit beyond what your insurance company will pay, we want to make sure you've talked to them and understand what your benefits are.
Please email us if you have any questions after speaking with your insurance company and we can have our biller help to make things as transparent as possible for you. If you have questions, you can send us a copy of the completed form above, or of the front and back of your insurance card with your birthdate. Thanks!
If you're being treated for a MOTOR VEHICLE ACCIDENT: You don't need to fill out this form. We will contact your adjustor and verify the claim for you. We just need you to email us or call our billing company directly ((541) 420-2615) with your: company name, claim number, adjustor's name and adjustor's phone and we will get back to you as soon as possible.
AS OF MARCH 5TH, 2018, WE ARE NOT ACCEPTING NEW OREGON HEALTH PLAN (CARE OREGON) PATIENTS. WE'LL REVISE THIS WHEN WE CAN OPEN TO OHP AGAIN.