APOLOGIES:

I don't like filling out endless forms and yet on this page are several forms I am asking you to download, print out, fill in, and bring to your first appointment with me. The first 2 forms provide me with basic information about you that I will use for contacting you and for helping me to analyze your current health condition. The other 3 forms are required by law. It's that simple. I hope you understand.

 

1. Contact Information - This form primarily tells me how to get in touch with you and how you would like to be contacted by me and my office. It also asks for a list of any medications, supplements and herbs you are taking, because these might have an effect on your treatment.

 2. Medical History - My form is a somewhat standard questionnaire, asking about your current health issue(s) and including a checklist which reviews the systems of your body. Your medical history helps me to understand some of the context surrounding your current health concern.

 3. Informed Consent - The first part of this form explains various treatment modalities I might use to treat you and the possible risks involved in each one. The second part of the form requires your consent, in order for me to treat you with acupuncture and Eastern/Oriental medicine.

 4. Privacy Policies - I am required to give you or offer you a copy of my clinic privacy policies. You may read this form online, print it out, or ask me to give you a paper copy.

 5. Acknowledgement of Privacy Policies - I am required to have you sign this form acknowledging I have shared my privacy policies with you.

 

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Contact Information.pdf
Adobe Acrobat Document 79.7 KB
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Medical History.pdf
Adobe Acrobat Document 181.1 KB
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Informed Consent .pdf
Adobe Acrobat Document 52.8 KB
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Privacy Policies.pdf
Adobe Acrobat Document 100.4 KB
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Acknowledgement of Privacy Policies.pdf
Adobe Acrobat Document 24.7 KB