New Patient Form
Please contact our office for an appointment before filling out this form.
Due to the format of online form, some elements are condensed for better navigation. We recommend reviewing the following terms and conditions before filling out your new patient form:
- Liability Weaver, Insurance Disclaimer and Cancelation/No Show Policy
- Acupuncture Informed Consent to Treat
- Arbitration Agreement
- HIPPA Notice of Privacy Practices
The same original PDF can be previewed during your form entry session. After submission, you will have an opportunity to download your signed form.