Clinic Forms

 

 

 

New Patients: For your convenience you may print and fill out all forms below to speed up the intake process during your first visit.  If you prefer to fill out forms when you arrive at our office be sure to arrive 15-20 minutes before your scheduled appointment time.

Medical History Form  (PDF, Adobe Reader required)

Patient Contact Information Form

Acupuncture Informed Consent to Treat

HIPPA Notice of Privacy Practices 

Initial Assessment Form (“10 Questions”) 

Financial Policy