Coupon

We would like to thank you for visiting our web site. Sign up below and you will receive a coupon of $30 value immediately. It is good for one initial exam and limited to one coupon per person. If ever you, your friends, relatives or colleagues are in need of our services, please print out this coupon and bring it when visiting us. Your no-cost, no-obligation initial exam includes:

	A relaxed consultation with the Doctor
	An individual health and injury history
	Extensive exams of pulses and the appearance of the tongue, eyes
	A discussion of findings and recommended treatments
	15 minute massage

* Your Name:

Prefix:

Mr. Ms. Mrs.

* Telphone Number :

* Email:

* City of Living:

* Employer:

Referred by:

* Insurance Name:

(to verify your insurance benefit)

* Insured Name:

(to verify your insurance benefit)

* Insured Date of Birth:

(to verify your insurance benefit)

* Insured ID#:

(to verify your insurance benefit)

* Insurance Type:

HMO PPO EPO POS
Kaiser Auto Insurance Workers' Comp.

(* required information)

Because we would like our web site shared by all, if you tell another visitor about our site and they also use this coupon for their initial visit you will receive $20 OFF of your next office visit. Just have them fill out your name in the referral area and we will attach this to your file so that you will receive your discount next time you are in to see us.


It's Our Mission to Help As Many People As Possible!