Request Insurance Intake Form
Use this short form to ask Path Acupuncture & Herbal Medicine to send you the insurance intake form. The initial request asks only for your name, phone number, and email address so our office can respond to your request.
Do not enter insurance numbers, medical information, appointment details, or sensitive messages here. The clinic requests detailed insurance information later through Jane.
Review current insurance information before submitting if you would like to see the plans and networks the clinic currently works with.
Before you submit
You may submit a request even if your plan is not listed or you are unsure whether the clinic works with it. The office will review the information you later provide through Jane before explaining what it can confirm.
Submitting this request does not confirm eligibility, coverage, authorization, reimbursement, payment, or appointment availability.
How the insurance intake process works
1. Send your contact information
Complete the short form below with your first name, last name, phone number, and email address. Do not include insurance or medical details in this initial request.
2. The office prepares your Jane intake
Our office creates your patient profile in Jane and sends the insurance intake form through Jane using the contact information you provide.
3. Complete the detailed intake
You complete the insurance intake form in Jane with the information the clinic needs for its review.
4. The office reviews available information
After receiving the completed intake, the clinic reviews the available benefits, referral requirements, and prior authorization requirements for your plan.
5. The office contacts you
After the review, the clinic calls you to explain the available benefit information and next steps. Information from an insurer can change, and the insurer's processing and final determination control coverage and payment.
Request the insurance intake form
Enter contact information only. Required fields are marked. Do not include insurance identifiers, medical information, appointment details, or sensitive messages. By submitting this form, you are asking Path Acupuncture & Herbal Medicine to contact you by phone or email about your insurance intake request. This is not consent to marketing messages. Review our Privacy Policy.
Important insurance information
Submitting the form begins an administrative intake request. It does not confirm that Path participates with your plan or that acupuncture is eligible, covered, authorized, reimbursable, payable, clinically appropriate, or available for scheduling.
Benefits, referrals, prior authorization, covered diagnoses, visit limits, patient responsibility, and payment depend on the individual plan and current information available during review.
Need another way to reach us?
If you cannot use the form or need help with the request, call the clinic at (702) 202-3383. For plan and network information, visit Using Insurance for Acupuncture in Las Vegas.