Please complete the following form and submit your photo. It may take up to 5 business days to verify license information and post.
Your Name (required)
Company Name (Professionals) or School (Students)
Your Email (required)
Credentials
Languages Spoken
Biography
Office Address
Suite#
City (required)
State (required)
Zip (required)
Phone Number (required)
Fax Number
Web Address
Insurance
Yes No
Type of Insurance Accepted
In-Network Out-of-Network Flex Plan/HSA Medpay
Colorado License # (required)
Co. License Exp. Date (required)
NCCAOM Certificate #
NCCAOM Exp. Date
Year Graduated (Professionals) or Expected Year of Graduation (Students)
Other Certifications
Treatments Auricular (ear) Bioset Community Style Clinic Five Element Japanese Korean Medical Acupuncturist Scalp TCM Trigger Point Release Veterinary NA
Techniques & Modalities Acupuncture Acupressure Aromatherapy Cupping Diet and Lifestyle Therapy E-Stimulation Gua Sha Herbology Injection Therapy & Biopuncture Laser Medical massage Moxa Magnets N.A.D.A (National Acupuncture Detoxification Association) NAET (allergy elimination) Plasters & Liniments Qi Gong & Chi Kung Tui Na Tuning Forks & Sound Therapy NA
Specialties Addiction – other Allergies Arthritis Asthma Autoimmune Disease Colds & Flu’s Cosmetic Chronic Fatigue Dental Dermatology Diabetes Family Practice Fertility Fibromyalgia Gastro Intestinal & Digestive Geriatrics Headache & Migraine Hepatitis HIV & AIDS Hypertension Men’s Health Musculo-Skeletal Neurological Insomnia & Sleep ObGyn Oncology Osteoporosis Pain – Musculo Skeletal Pediatrics Psychological & Emotional Respiratory Sexual Dysfunction Smoking Cessation Sports Medicine Stress, Anxiety & Depression Weight Management Women’s Health NA
Company Logo or Photo (it is best to upload a smaller image around 400px on the longest edge.)
