NEW PATIENT INFORMATION FORM
Please print and bring completed forms to your first appointment.
Insurance Coverage Worksheet.
Please print out and complete this form if you have insurance coverage for acupuncture, and bring it to your first appointment.
Follow these guidelines to get the most out of your acupuncture treatment.
1. We look at the tongue to diagnose your condition, so do not brush your tongue the morning of your treatment. Do not eat or drink colorful food/liquid beforehand.
2. We access your body’s own healing energy to treat your condition, so please come to your appointment neither too hungry nor too full.
3. After acupuncture treatment, feel free to eat and drink, but with moderation. To maximize results, your Qi energy needs to stay in the channels that we have worked on. Eating or drinking too much will divert this energy from the channels to your stomach.
4. If possible, wear a loose fitting two piece outfit. Loose fitting clothing allows energy to circulate freely in the channels. No worries if you come straight from work – we provide towels for privacy if you need to undress.
5. Please remove all makeup from your face. We observe your facial color and skin tone to accurately diagnose your condition.
6. Please wash or wipe clean your hands, feet and sweaty areas on your body to fully allow the cleansing energy of acupuncture to enter your body.
7. Try not to read or watch electronic devices during your treatment. Quieting the mind is the best way for your energy to work appropriately with the needles to get the best results.
8. We will give you suggestions on what to do at home. Follow these instructions to get the best results. Acupuncture and Chinese medicine are natural healing systems that integrate with a person’s lifestyle. If the lifestyle fits in the natural balance, the results will be excellent.
9. For chronic, severe conditions please give the treatments time. The condition took a long time to develop, therefore the reverse is true–healing of the condition will take a while.
10. Please leave your electronic devices in your car or turn them off before entering into our clinic. The electronic waves are toxic to the body and mind. Try to shut these device off as often as you can in your daily life as well.
11. Please do not take phone calls in our office. If you must take a call, please step outside so other patients are not disturbed.
12. Please stay home if you have a cold, infection or stomach virus that can easily spread to other people. We treat immune compromised and elderly patients who can not afford to get sick. This way, you feel safe as well.