Informed Consent & Arbitration Agreement
To be treated at Traditional Chinese Acupuncture Clinic, all patients must sign the following forms:
This office uses an arbitration agreement required by its insurance carrier. Arbitration helps to keep the cost of insurance low and subsequently lowers the cost of healthcare for our valued patients. For additional information, click here.
Cost of acupuncture treatments
First treatment: $90 (1.5hr; includes TCM assessment of presenting complaint, review of health history, and acupuncture treatment)
Subsequent treatments: $60 per visit
Please note: I do not double-book patients and I prefer to not charge for missed appointments as I understand sometimes "life happens." I ask in return that patients notify me as soon as possible, preferably at least 24 hours prior, if they need to cancel their appointment. I also ask that patients be considerate of other patients' appointments following theirs and arrive no later than 15 minutes.
Payment in full is due at the time of service
We offer a Time of Service Discount of 10%.
Payment forms accepted: Cash, Personal Check, & major credit cards (Visa, Mastercard, American Express, & Discover) including chip and contactless (NFC) payment methods (ApplePay, etc.) processed by Square.
Returned check fee: $25.
Insurance is not accepted at this time, but a statement with the relevant information for submitting to your insurance company may be requested. Each plan is different, so check with your insurance company first whether your plan covers acupuncture.
Our Clinic Protects Your Health Information and Privacy
This notice describes our office’s policy for how medical information about you may be used and disclosed, how you can get access to this information, and how your privacy is being protected.
In order to maintain the level of service that you expect from our office, we may need to share limited personal, medical, and financial information with your insurance company¸ with Worker’s Compensation (and in this instance your employer as well), or with other medical practitioners that you authorize.
Safeguards in place at our office include:
Limited access to facilities where information is stored.
Policies and procedures for handling information.
Requirements for third parties to contractually comply with privacy laws.
All medical files and records (including email, regular mail, telephone, and faxes sent) are kept on permanent file.
Types of information that we gather and use:
In administering your health care, we gather and maintain information that may include non-public personal information:
About your financial transactions with us (billing transactions).
From your medical history, treatment notes, all test results, and any letters, faxes, emails or telephone conversations to or from other health care practitioners.
From health care providers, insurance companies, workman’s comp and your employer, and other third part administrators (e.g. requests for medical records, claim payment information).
In Kentucky, you may access and correct personal information we have collected about you, (information that can identify you - e.g. your name, address, Social Security number, etc.). We reserve the right to change or alter our practices and policies. In such an event, an updated policy will be mailed to the address you provided to us and posted on this website www.tcmacupuncturelex.com.
We value our relationship with our patients and respect your right to privacy. If you have questions about our privacy guidelines, please call the office at 859-913-5638 or send an email to firstname.lastname@example.org.
Download a copy for your records here.