Forms

Please print and complete these forms and bring them with you for your first appointment. Otherwise, please arrive 15-20 min. early to complete them in the office.

For all patients:

• Intake Form
• Patient Registration
• Glow Policies
• Credit Card Auto-billing Form

Appointment-specific forms:

• Fertility Acupuncture Intake– Female
• Fertility Acupuncture Intake  Male
• Auto Accident Questionnaire
• Psychotherapy Professional Disclosure
• Release of Medical Information
• Pediatric Acupuncture Intake
• Brief Assessment Functional Medicine