The forms you will need are 1-6 to get started, the Comprehensive Acupuncture Examination forms #7-10 allow you to give me a complete picture of your health you may want to fill these out as well.
You can verify your insurance by filling out the insurance verification form #6 and fax it to the number at the bottom of the page.
By filling out these forms before coming in we can spend more time on you and less time on paper work.
- 1. Intake Short Form (198.85 Kb)
- 2. Informed Consent for Acupuncture Treatment (73.45 Kb)
- 3. 5 Element Intake (198.85 Kb)
- 4. Financial Policy (160.39 Kb)
- 5. Privacy HIPPA (91.81 Kb)
- 6. Insurance Verification (25.43 Kb)
- 7. Comprehensive Acupuncture Examination Page 1 (1095 Kb)
- 8. Comprehensive Acupuncture Examination Page 2 (1432 Kb)
- 9. Comprehensive Acupuncture Examination Page 3 (1018 Kb)
- 10. Comprehensive Acupuncture Examination Page 4 (864 Kb)
- 11. Biopuncture Pamphlet for Patients (99 Kb)
- 12. Informed Consent Biopuncture (193 Kb)
The above documents are in PDF format. If you need the Adobe Reader download it here