Forms

Forms include information on the following policies:

• HIPAA Privacy policy
• Notice of Privacy and Patient Acknowledgement
•  Informed Consent
• Financial Policy
• Patient Missed Appointment Policy (Cancellations) 

Initial Appointment Intake forms:

Acupuncture - Includes Insurance Benefit Check Form

Massage

Insurance for Acupuncture: 

Insurance Intake Form (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.

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.