Patient Signup Process

Skilled acupuncture services is committed to providing treatment for chronic low back pain for elderly per CMS guidelines. 

CMS requires the primary care provider to prescribe it acupuncture for those who are eligible. To facilitate this process we have created an initial acupuncture eligibility questionnaire for patients to fill out that can then be given to the primary care provider to sign off on, allowing for 12 acupuncture visits. 

After the initial 12 visits, patient will be requested to fill out an additional questionnaire substantiating the benefits of treatment.  The PCP can use this documentation to sign off on an additional eight visits.

To begin receiving treatment, please fill out the forms below and email:

1. Have potential patients fill out: Initial Acupuncture Eligibility Questionnaire 

     Send to the Primary Care Provider for signature. 

2. Have interested patients sign: Informed Consent/ Arbitatration Agreement

Once patients receive 20 visits of Acupuncture in a year, they may continue to receive acupuncture at an out of pocket expense of $50 per treatment.