Forms

New Patients: Print and fill out these forms to speed up the intake process during your first visit.

Intake Questionnaire (PDF, Adobe Reader required)

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Our practice does accept out of network insurance for acupuncture patients. In order to best serve you, please verify your insurance benefits before you arrive. Please click on the link below and complete the online form. We will contact you as soon as the benefits are established. We proudly treat veterans through the Veterans Choice Program associated with the VA. For more info on this program, please call us directly.
Verify Your Insurance
Three Moons Acupuncture

310 Old Green Bay Road
Kenosha, WI 53144

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(262) 977-8793
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If you need to cancel or reschedule your appointment, please do so at least 24 hours in advance. Thank you.

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