Forms

Dear Patient,

Here resides our list of forms.

Notice of Health Information Privacy Practices:

• Notice of Health Information Privacy Practices

New Patients:

• Patient Registration Form
• Insurance & Financial Policy
• General Consent for Treatment

Women's Health Patients:

• GYN Questionnaire

Acupuncture & FSM Frequency Specific Microcurrent Patients:

New patients please also complete & bring New Patients forms

(Patient Registration Form, Insurance & Financial Policy , General Consent for Treatment)

• Informed consent for Acupuncture/ FSM
• Body Pain Map
• Acupuncture & FSM Form

Release of Medical Records:

• Authorization for Use and Disclosure of Health Information