Acupuncture Forms
Please print and thoroughly complete all forms listed below and bring them with you to your initial appointment.
- Acknowledgment Of Receipt Of Notice Of Privacy Practices
- Authorization For Release Of Health Information
- Health History Questionnaire
- Patient's Consent For The Purposes Of Treatment, Payment, And Healthcare Operations
- Privacy Policy Statement
- 24 Hour Appointment Cancellation Policy
Advanced Allergy Symptom Relief Forms
- New Patient Information Form:
This form covers the clinic's policies. Please print and review this form. A completed copy will be given to you at the end of your initial appointment. - Patient Intake Form:
This form will give the practitioner the information needed to proceed with your assessment and ensure the most comprehensive treatments possible. Please thoroughly complete the form and sign at the bottom. Your signature on this form will indicate that the New Patient Information Form has been reviewed. Please bring this completed form with you to the initial appointment. - 24-Hour Appointment Cancellation Policy Form:
This form covers our cancellation policy. After reviewing this form, please sign at the bottom and bring it with you to the initial appointment. - Privacy Policy Statement:
This is our privacy policy. Please print and review. - Acknowledgement of Receipt of Notice of Privacy Practices:
Please review, complete, and sign at the bottom. Kindly bring the completed form with you to the initial appointment.