We can provide you with a receipt that you can submit to your insurance for reimbursement. This includes date(s) of treatment(s), the amount paid, as well as diagnosis and treatment code.

Please note:
• There is a $29.00 administrative fee for this additional service
• Multiple treatments can be included in a single receipt request
• It can take 1-2 weeks to be completed
• WE CANNOT GUARANTEE THAT YOU WILL BE REIMBURSED

IMPORTANT: Before you start this request form please contact your insurance provider for a list of all the information you need from us.