Forms include information on the following policies:
  • Financial / Insurance
  • Cancellation
  • Informed Consent

Initial Appointment Intake forms:

Acupuncture - Includes Benefit Check Form


Nutrition - Men

Nutrition - Women

Nutrition - Children

Insurance for Acupuncture: 

Benefit check form ONLY, for rechecks and updates.
**Established Patients: Please use this form if you have a new insurance policy or your policy has changed.
New Patients: Please complete the entire Acupuncture Intake Form packet, from the section above.

Re-Visit forms:

Nutrition Revisit Symptom Questionnaire

Financial Policy:

Financial Policy
If you are not able to submit these forms by fax, or scan them as an attachment via email, please call our office, and we can take the information needed over the phone, and collect the forms at your first appointment.