Skip to content

New Patient Forms

New patients, please download and Complete the appropriate forms prior to your first appointment.

*Clinic Guidelines for Covid-19 and Patient Safety Consent

Informed Consent/New Patient Health History

Covid-19 Response Plan (Read Only-does not need to be printed out.)

HIPAA Notice of Privacy Practices (does not need to be printed out)

Insurance Form (only fill out if you have acupuncture coverage) – We do not bill insurance. All services are self-pay. A superbill can be provided as a courtesy for reimbursement, should you have coverage. Acupuncture is covered through HSA and FSA accounts.

colorful paper cranes

586.221.0650 Directions Contact/Schedule