NEW PATIENT

Insurance Patients:

We are an out-of-network provider.  Please check your acupuncture out-of-network coverage before scheduling by calling the customer service phone number on your insurance card or checking online. Contact us by completing the form below to see if your plan covers our services. If you have coverage upon verification, we will estimate your deductible in advance. Your deductible and co-insurance will be charged at the time of service.

acupuncture-insurance-logos1


Cash Patients:

Call our office for our current fees.

Schedule your appointment by calling the office at  (305) 412-0011 , (954) 544-4545.

Patient Name*

Billing Address*

Select State*
Phone Number*
Patient Date of Birth (MM/DD/YYYY)*
Patient Marital Status*

Insurance Card ID #*
Insurance Card Group #*
Insurance Company Name*
Insurance Company Phone# (for providers)*
Chief Complaints (reason for seeking care)
Insured Name (If different from patient)
ID # (If different from patient)
Relationship to Insured

Download, fill out and bring the following paperwork to your first appointment:

  1. Comprehensive Health Examination Form : Click here to download!
  2. New Patient Consent Form: Click here to download!
  3. Patient Food Diary Form : Click here to download!
  4. Release Form : Click here to download!
Patient Name*

Billing Address*

Select State*
Phone Number*
Patient Date of Birth (MM/DD/YYYY)*
Patient Marital Status*

Insurance Card ID #*
Insurance Card Group #*
Insurance Company Name*
Insurance Company Phone# (for providers)*
Chief Complaints (reason for seeking care)
Insured Name (If different from patient)
ID # (If different from patient)
Relationship to Insured

Your First Visit

Make travel plans to allow yourself plenty of time.  We have free parking in the front of our building.

Check in at the front desk 10-15 minutes prior to your scheduled appointment time.

We have a 24-hour cancellation policy: Please make any cancellations within that time frame.

Your first visit will last around 60 to 90 minutes. This initial visit includes an in-depth assessment of your health concerns, and a gathering of information on all aspects of your health. A few key physical examinations will also be conducted. Dr. Fuentes will review your health history and current health situation and may recommend additional diagnostic testing. A comprehensive and personalized treatment plan will  be developed for your specific condition. Your treatment will start on the first visit but may be adjusted following the review of subsequent diagnostic tests. Follow up treatment sessions generally last 60 minutes although for some conditions may be shorter.

Dade-Map

Miami-Dade County

9420 SW 77th Ave Suite 101
Miami, Fl 33156
Tel. (305) 412-0011
Fax. (305) 412-3837

Broward-Map

Broward County

12251 Taft Street – Suite 303
Pembroke Pines, Fl 33026
Tel. (954) 544-4545
Fax. (954) 544-4543

Schedule An Appointment Form