If you are currently a member of AcuCare and need to make a change to your profile you may download and print the applicable forms. Please complete and applicable sections and either mail to AcuCare, 2500 E. Foothill Blvd., Suite 401A, Pasadena, CA 91107 or fax to AcuCare 626.793.3346.
PROFILE
CHANGE/CORRECTION
Includes:
- changes to personal information such as name, mailing address, gender and
TIN # changes.
- clinic information for address removals, corrections and additions.
All NEW addresses must have a site inspection if you want the location listed, and if you plan to submit claims to our payors for patients treated at this location. We charge a one-time $60 fee for each site inspection performed. Please include this fee along with your new address information and mail it to the above address.
TAX I.D. W9 Form CHANGE/CORRECTION
- this form must be completed and signed and returned to us in order to report
to our payors. You may either mail or fax this document.
Or Contact
Us