New patients: Electronic Questionnaires (intake forms and consent forms) will be sent to you via the portal upon scheduling. Questionnaires need to be filled out prior to the day of our first appointment. This allows Dr Jen time to prepare for your visit and for efficient use of the office visit time. If paperwork is not completed ahead of your scheduled appointment time, you may be asked to reschedule.

Insurance: I am in network with the following insurance companies:

• Blue Cross

• Aetna

• Moda

• Pacific Source

• Providence

• TriWest (acupuncture only)

I bill insurance as a courtesy to my patients. Patients are responsible for understanding their benefits. Benefit plans vary and naturopathic and acupuncture services are not always covered services. All insurance payments (copays, co-insurance) are handled by my billing company and are not collected in the office. You will receive a statement from the billing company once they have received reimbursement from your insurance company. You are responsible for what insurance does not cover so I strongly recommend using the form below when you call your insurance company. Currently, I may be listed as either Jennifer Carroll or Jennifer Cicilian under your plan as my name has changed in the past year and updates are still occurring.

Health Insurance Verification Form

If you have had any lab work done in the past two years, please upload to the portal documents section or send to me via messaging on the portal. If you do not have copies of your labs, most can be downloaded by you directly from your MyChart account, providers portal, or the lab directly. If you are unable to obtain your results on your own, you can fill out the release of records form below and request your provider send them to me directly.

Medical Records Release Form

Required Paperwork: (Note: electronic questionnaires will be sent to you upon scheduling. The below forms are only to be used in the event of an issue with accessing your electronic forms. If an issue arises you may fill out these forms and return to Dr Jen prior to the day of our first appointment.

New Patient Health Intake

Office-Financial-Insurance Policy, Consent to Treat

Privacy Policies/HIPPA

Acupuncture Consent Form