Acupuncture Works Center

Helpful Forms

The following forms are designed to help us work together more easily. On an initial office visit a person would fill out all three of these forms. This will give me a clear picture of not just the "problem" but of your constitiution in Chinese Medicine. 

Intake Chinese Medical Form A front

Intake Chinese Medical Form A front

Intake Chinese Medical Form A back

Intake Chinese Medical Form A back

Welcome Sheet front

Welcome Sheet front

Welcome Sheet back

Welcome Sheet back

Consent to treat

Consent to treatment

attest form

attest form

Microneedling and Light therapy Form

Microneedling and Light therapy Wavier and consent to treatment

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