top of page
Patient Forms

Patient Forms

Welcome Letter and Treatment Tips

New Patient Form

Insurance Authorization and Billing

Pediatric Intake Form (0-13 Years Old)

Consent for Cosmetic Acupuncture

Cosmetic Acupuncture Intake Form

HIPAA Notice

COVID Consent for Treatment


Photo: Jeffrey R. Schwartz

  • How does acupuncture work?
    Acupuncture treatment is based on an Asian medical diagnosis that includes an assessment of pulse quality, shape and color of the tongue, medical history, and whole body evaluation. Following the diagnosis, acupuncture points are chosen on the body along acupuncture meridians, or pathways. Needle stimulation of these points increases the body’s healing energy or Qi (pronounced chee). The body has approximately one thousand acupuncture points. Good health depends on the smooth flow of Qi. When the flow of Qi is blocked due to trauma, poor diet, medications, stress, hereditary conditions, environmental factors, or excessive emotional issues, the system is disrupted and illness is then generated. In accordance with ancient theory, acupuncture allows Qi to flow to areas where it is deficient and away from areas where it is in excess. In this way, acupuncture regulates and restores a harmonious energetic balance in the body. There is a Chinese saying, “There is no pain if there is free flow; if there is pain, there is no free flow.” Scientific research has discovered that acupuncture points show a variety of unique bioelectric properties. Stimulation of acupuncture points cause definite physiological reactions affecting brain activity, such as releasing pain-killing endorphins, influencing blood pressure, enhancing the immune system, balancing the sympathetic and parasympathetic nervous systems and enhancing the endocrine system. Most of all, acupuncture stimulates the body’s natural ability to heal itself, regain homeostasis, and maintain its relationship with nature. Acupuncture can treat a variety of conditions, including chronic pain, musculoskeletal injuries and diseases, neurological disorders, digestion, and women’s health.
  • What are acupuncture needles like?
    Acupuncture needles are sterile surgical grade steel needles. The needles used in almost all clinics in the U.S. are single use needles. This means that they come from the manufacturer in sterile packaging and are only opened immediately before insertion. The needle itself is only slightly thicker than a human hair. Acupuncture needles are solid unlike the hypodermic needles used by physicians, which are designed to inject fluids and medications.
  • Is acupuncture painful?
    Acupuncture needles are normally inserted only into the topmost layers of skin and rarely, if ever, cause bleeding or bruising. However, there can be some soreness or slight pain as it is inserted. As long as a trained professional is giving the treatment, many people feel nothing at all. It is important to seek treatment from a qualified acupuncture practitioner to ensure proper needle placement and stimulation. In any case, if you experience discomfort during or after the treatment, it is usually mild and short term. Because the purpose of acupuncture is to balance your body, there are no long-term negative side effects. On the contrary, relaxation and a sense of well-being often occur during and after treatment. Often patients become so relaxed that they fall asleep during treatment.
  • How many treatments will I need?
    Each patient is unique and responds to acupuncture differently, so the number and frequency of treatments will vary from patient to patient. The number of treatments needed to address a specific health concern depends upon the duration, severity, and nature of your complaint. You may need only a single treatment for an acute condition or a series of five to fifteen treatments to resolve more chronic problems. Your constitution, severity of the problem, and the length of time that you have been sick will all play a part in this. Since acupuncture addresses the health of the whole body, there are many people that seek regular acupuncture treatments to maintain good health and as a preventative measure.
  • What should I expect at my first treatment?
    At your first treatment, your practitioner will spend some time talking to you and going over your intake form to address any specific conditions you may be seeking treatment for. They will ask about your medical history, observe your tongue, and take your pulse, asking for more detail about your illness or pain so they can best treat it. Your initial session will usually last one and a half to two hours including this initial consultation. It is recommended that you wear comfortable, loose fitting clothing that can be rolled up if necessary. You may be treated lying down on your back or stomach, and acupuncture needles may be placed almost anywhere on your body, including your scalp, forehead, hands, arms, stomach, back, hips, legs, feet, or toes. If you are uncomfortable at any point during the session, please speak to your practitioner so they can help you adjust your position or change needles as necessary.
  • What is pulse diagnosis?
    One of the most common questions that patients ask about Chinese Medicine is: "Why does my practitioner check my pulse?" Pulse diagnosis is actually one of the most complex and important diagnostic techniques we use in Chinese Medicine. Through feeling and evaluating your pulse, I obtain an accurate diagnosis of your overall constitution, Qi (energy) flow, and internal organ health, among other things. I then synthesize all of this information into a highly effective and individualized treatment plan for your specific needs.
  • What is tongue diagnosis?
    Tongue evaluation consists of visually inspecting the tongue body for vitality, color, shape, moisture, and movement, as well as assessing the tongue coating for color, thickness, distribution, and characteristics at the root. According to TCM theory, the tongue provides a geographic map of organ systems; characteristics of the tongue in each of these areas provide information critical to the TCM diagnosis. Tongue diagnosis is considered a pillar of TCM diagnosis because it provides clearly visible clues to a patient’s pattern of disharmony. The tongue can present strong visual indicators of a person’s overall harmony or disharmony.
  • What level of education do acupuncturists need to be licensed?
    To qualify for licensure in New York, a practitioner must qualify for and pass the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) Acupuncture Board exam. To qualify to sit for the NCCAOM exam, a student must complete a 4050-hour master degree level program at a NYS approved school and complete 650 hours of supervised clinical acupuncture experience. Entrance into an approved school requires at least 60 semester hours at an accredited college or university. Including at least 9 semester hours in Biosciences. Throughout the licensing period the licensed practitioner is required to participate in state and nationally recognized continuing education classes, equalling at least 60 hours. Do not rely on an medical diagnosis of disease by an acupuncture practitioner who does not have substantial Asian medical training. Doctors certified in “medical acupuncture” by the American Board of Medical Acupuncture are required to take only 200 hours of classroom training in acupuncture and 100 hours of clinical training. Just because an individual is a medical doctor, it does not automatically mean that he or she has also had Asian medical training.
  • What is the NCCAOM?
    The National Certification Commission for Acupuncture and Oriental Medicine is an advisory board governing measurable competency and knowledge of the practitioners you entrust with your health and care. All NCCAOM certified practitioners adhere to a strict code of ethics and professional discipline: As a Diplomate of the NCCAOM®, I hereby pledge my commitment to the following principles: Respect the rights, privacy and dignity of my patients and maintain confidentiality and professional boundaries at all times. Treat within my lawful scope of my practice and training and only if I am able to safely, competently and effectively do so. Allow my patients to fully participate in decisions related to their healthcare by documenting and keeping them informed of my treatments and outcomes. Accept and treat those seeking my services in a fair and nondiscriminatory manner. Render the highest quality of care and make timely referrals to other health care professionals as may be appropriate. Continue to advance my knowledge through education, training and collaboration with my colleagues to maintain excellence and high ethical standards in our profession. Support my medicine’s access to all people and its growth in the broad spectrum of U.S. health care. Assist in the professional development and advancement of my colleagues. Participate in activities that contribute to the betterment of my community.
  • Do you accept insurance?
    Good news! Acupuncture care is being covered by more and more insurance companies. We have a few options available to see if your health insurance covers acupuncture care. You can come in and visit us while we call your insurance company on your behalf, or feel free to call us at (917) 868-4735, provide your insurance information, and we will call for you. It is that simple! You can also call your insurance company’s patient information or benefits line on your own to see if your carrier provides acupuncture benefits. This number can be found on your insurance card. If your insurance provider does cover acupuncture, here are a few questions that you can ask to determine your eligibility and coverage: - How much does the insurance company pay? - What is the normal co-pay for acupuncture from a preferred provider? - What percentage will I pay for out-of-network practitioners? - Who must provide the acupuncture? - What is my deductible? - What conditions are covered for acupuncture? Regrettably, Medicaid and Medicare do not provide coverage for acupuncture. We will continuously monitor legislation to see if this changes in the future. Motor Vehicle Accidents / No-Fault Benefits: ​ If you have suffered a personal injury in an auto or motor vehicle accident, you or the other parties car insurance will pay for acupuncture treatments. We will work closely with your car insurance carrier to receive these benefits. Billing of Insurance Companies: ​ Most of the time, we will expect payment up front for your visit and we will provide a Superbill for your convenience to submit to your insurance company to reimburse you. Another option would be for us to bill directly to your insurance company and have you assign over the payments to us. Call us and we would be happy to discuss this further!
bottom of page